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Go undetectable and beyond through comprehensive HIV treatment

In this video, three HIV specialists discuss their experiences and thoughts related to setting treatment goals with their patients.
View transcript below.

According to the most recent data available from the CDC, in 2011, 82% of HIV-infected patients who were engaged in care and were prescribed ART achieved suppression. Start with setting the right goals for your patients.

DERRICK BUTLER, MD: So, Cynthia and Leandro, what are the key treatment goals for patients who initiate ART?

CYNTHIA RIVERA, MD: My main goal is to get started as soon as possible and maintain whatever immune system function we have, maintain that, perhaps build it, and get our viral loads as low as possible as fast as possible, with the goal to get completely virologically suppressed.

LEANDRO MENA, MD: I totally agree with that. I think that’s the means to get to the endpoint which is reduce HIV morbidity and mortality. We know that patients who are in care and take medications, who achieve viral suppression, can maintain viral suppression, can significantly reduce HIV-associated morbidity. 

CYNTHIA RIVERA, MD: When starting antiretroviral therapy, I think that first conversation is crucial, making sure that patients understand that we’re very much wanting to preserve their immune function, making sure that we keep them as health as possible as early as possible, and getting their viral loads undetectable as soon as we can. And then we’re not only thinking about the patients, we’re also thinking about making sure that we help prevent transmission by getting our viral loads as low as possible.

LEANDRO MENA, MD: I agree. I think as a clinician, our goal is to, as Cynthia mentioned, get patients on treatment as soon as possible. But I think some of the challenges is that while we understand that it’s sometimes difficult to translate to our patients, right, those goals, some of my patients, you know, don’t see their lives in such a long-term kind of perspective. And how do kind of translate that in a way that makes sense to the patient is a little bit of a challenge.

DERRICK BUTLER, MD: I agree, and I think a lot of time patients come into your practices with lots of misinformation, sometimes issues of stigma, guilt, shock about having the diagnosis, so you have to kind of weed through that to get them to understand that their goals are to stay healthy and their goals are to get the virus down to undetectable levels and that they can do it. I mean that’s the other part too. 

CYNTHIA RIVERA, MD: On the flip side we have young patients who are so healthy and maybe really are not felling the effects of being infected with HIV, and so they will come in and those conversations need to be had more so that they understand the importance of not only keeping them healthy long term but preventing transmission.

LEANDRO MENA, MD: The evidence that we have in the last few years of treatment as prevention has really been a game changer that I believe is going to have a great impact reducing HIV stigma. One of the strategies that I use when I talk to patients who are newly diagnoses is I try to help them visualize who were they on the day before they learned they were infected, what were their goals? I tell them, you know, it’s exactly the same thing. The only that has changes is now you know and that knowledge has empowered you to make sure that you do what you have to do.

 

Taking a comprehensive approach to therapy can be a step toward setting up your patients for long-term treatment success

The US Department of Health and Human Services (DHHS) guidelines recommend the use of a complete triple therapy based on a dual nucleoside reverse transcriptase inhibitor (NRTI) plus an integrase strand transfer inhibitor (INSTI) for treatment initiation.1

Starting in 2009, DHHS began recommending

to achieve and maintain virologic
suppression for treatment-naïve patients1,2

Consider these treatment attributes that can contribute to comprehensive HIV care

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Rapidly achieves and maintains durable viral suppression

According to the DHHS guidelines, the key goal of antiretroviral therapy (ART) is to achieve and maintain durable viral suppression. After initiation of effective ART, viral load reduction to below limits of assay detection usually occurs within the first 12 to 24 weeks of therapy.1
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Has a high barrier to resistance

Resistance barriers for antiretrovirals vary from low to high, based on the interplay among key contributing factors.1
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Provides a safety and tolerability profile that supports aging with HIV

The safety and tolerability profiles of ART are incredibly important factors to consider when choosing a comprehensive therapy. Providers should consider comprehensive HIV care that can support many stages of life.1
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Rigorously evaluated in diverse patient populations (age, sex, race)

A rigorously evaluated treatment may help you make decisions appropriate for the diverse patient groups you see in your practice.1,3
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Empowers providers to initiate treatment ASAP

ART should be initiated as soon as possible in all patients living with HIV, regardless of CD4 cell count.1

Consider whether your treatment approach sets up patients for long-term treatment success.

References:

  1. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services. Updated January 20, 2022. Accessed January 31, 2022. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/guidelines-adult-adolescent-arv.pdf
  2. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Updated November 3, 2009; Accessed November 8, 2021.
  3. US Food & Drug Administration. Clinical trial diversity. Updated November 19, 2021. Accessed January 12, 2022. https://www.fda.gov/consumers/minority-health-and-health-equity-resources/clinical-trial-diversity