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.