The first guidelines aimed exclusively at getting people newly diagnosed with HIV into treatment and keeping them on their medicines have been released by the International Association of Physicians in AIDS Care (IAPAC). Thirty-one leading AIDS experts developed the protocols using 325 studies involving tens of thousands of HIV patients.
People with HIV who miss their follow-up care within the first year of starting treatment have a death rate twice that of those who stay with a regimen, said Dr. Larry W. Chang, a guidelines co-author and an assistant professor at Johns Hopkins University. About two-thirds of HIV/AIDS patients never receive the most effective antiretroviral treatment available; just 59 percent of those on therapy stick with the regimen; and less than one-third have suppressed or nearly suppressed their viral load.
"Clearly, there is lots of room for improvement in how we, as care providers, can get new patients into treatment and help them adhere to the often strict drug regimens needed to suppress the viral disease and prevent drug resistance," said Chang.
The guidelines are an important prevention tool as well, since people with suppressed HIV are much less likely to transmit it to others, according to the researchers.
IAPAC strategies include helping the newly diagnosed navigate and find assistance, naming a point-person for questions about follow-up medications, and developing an automated alert system for physicians when prescriptions are not filled. Reducing the number of pills taken would be helpful, as would one-on-one counseling, the guidelines state.
IAPAC plans more research and an accredited, online medical education program for providers. "Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons With HIV: Evidence-Based Recommendations From an International Association of Physicians in AIDS Care Panel" was published online in the Annals of Internal Medicine (2012;e419).
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