Georgia is on the threshold of adopting a new national strategy to stem the spread of HIV and AIDS: starting drug therapy as soon as people are diagnosed, rather than waiting years until their immune systems weaken, the Atlanta Journal-Constitution has learned.
AIDS researchers say the new approach, called "treatment as prevention," reduces the amount of the virus in patients' systems. In addition to keeping them healthier, that can make them less likely to spread the deadly disease through sex or other means. The approach shows a real promise of reducing the number of new cases, the scientists say, a number that has stayed stubbornly constant in the face of previous prevention efforts.
But like the disease itself, this new strategy comes with a host of complications. For one, it may cost taxpayers more up front, even if it reduces long-term costs. For another, as many as half of Georgians diagnosed with HIV don't get regular tests to monitor their condition, so getting them to comply with a drug regimen may be challenging.
Dr. Patrick O'Neal, state director of health protection, called the new treatment guidelines "a major change from prior years." He said they should be in place in the next several months.
Georgia has among the highest HIV infection rates in the country, regularly ranking between 4th and 6th for new HIV and AIDS infections per year, O'Neal said. More than 40,000 Georgians are living with the diagnosis, and the state sees an additional 1,200 HIV infections and 750 AIDS cases each year, according to state figures.
The proposed guidelines arrive as Georgia struggles with a waiting list of several hundred people for programs that help people without means obtain medicine. O'Neal acknowledged that starting HIV drug treatment earlier could increase the waiting list for HIV drug assistance, which is funded with state and federal money.
"If the guidelines are changed so that more individuals qualify for receiving drugs, then yes, we would expect greater cost to the state unless the federal government provides additional funds," O'Neal said.
He estimated the additional cost of treatment for all the new cases at $10.4 million a year.
Some health providers expect the change to also increase Medicaid costs, because some HIV patients rely on the program to obtain medication and treatment.
Others argue that treating people earlier will save money in the long run, preventing people from getting full-blown AIDS and needing expensive hospitalizations. Beyond that, reducing the number of new cases will help control society's costs, said Diane Havlir, a professor of medicine at the University of California San Francisco.
Scientists have discovered that even before a person experiences symptoms, the disease can be damaging the heart, liver, kidneys and brain, she said. In addition, HIV drugs are now milder on the body, making it feasible for people to begin taking them earlier in their treatment.
"The reason the medical establishment used to wait to treat people is that the drugs had more side effects and toxicity," said Havlir, who will be co-chair of the International AIDS Conference in Washington this month. "Things have changed now."
For all the optimism surrounding the new guidelines, some advocates point out that many people diagnosed with HIV do not seek treatment.
O'Neal said that, for 55 percent of Georgians diagnosed with HIV, the state has no record of their following up with regular lab testing to track the infection's progress. He said, however, that is an estimate and may be high.
Treatment providers attribute the lack of follow-up to the costs of treatment and the lack of care in some poor and rural areas. In addition, some people simply can't face the diagnosis and put it out of their minds, advocates say.
Some believe they only need care if they feel sick, but a person can have HIV for years without experiencing symptoms.
"I just let it go," said a 35-year-old Atlanta woman who was diagnosed 14 years ago. She passed most of those years without treatment or medication.
The woman, who requested anonymity for fear her family would be harassed, said it took her mother's death and two bouts of meningitis to get her to take medication. She's been doing so for the past few weeks.
HIV service providers also had mixed feelings on the first rapid take-home HIV test, recently approved by the federal government. While it may lead more people to determine their status, they said it lacks the accompanying counseling that some people need before seeking care.
"I'm a little leery," said Jacqueline Brown, executive director of the Empowerment Resource Center in Atlanta, which provides programs and services on sexually transmitted diseases. "Some people need counseling. Many people just wait and do not go into treatment until it has progressed to AIDS."
While the majority of people infected are gay men, the disease is increasingly affecting heterosexuals and minorities, officials say. Moreover, the incidence is rising among people who are poor, homeless, drug addicted or mentally ill.
"Getting an HIV diagnosis is just another thing they have to deal with, and it's often not at the top of the list, like getting food on the table," said Lola Thomas, executive director of the AIDS Alliance of Northwest Georgia, based in Cartersville.
Thomas said that, despite the advantages of early treatment, the drugs can take a toll on a person's body over time. So she still has some concerns about people taking them for several additional years.
The new Georgia guidelines will not be mandatory, but in the past, guidelines have been widely accepted by infectious disease specialists and HIV physicians.
Terri Gardner, 56, of Bartow County, has followed the state guidelines since she was diagnosed in 2006. She did not go on medication, but underwent tests every couple of months to measure her T-lymphocyte count and viral loads, two measurements of HIV infection.
When she needed to start medication a few months ago, "it was like a slap in the face to me," she said.
The unemployed factory worker believes the new guidelines may help people stay healthier. But she's not sure that she would have wanted to start the medicines years ago, because she's concerned about side effects over time.
Even now she's a bit scared of the drugs, but having taken them for two months, she said, "I do feel better."
