PHP and city health department roll out policy to get all patients on treatment
Welcome! My name is Diane Havlir. I am a UCSF professor and a medical doctor specializing in HIVAIDS and I serve as both the chief of the HIV/AIDS division and chair of the Positive Health Program at San Francisco General Hospital. Thank you for visiting our website and for your interest in our work here to forward care, research and education in HIV/AIDS.
I am very pleased to announce a momentous initiative that marks a new era in HIV treatment. We here at San Francisco General, in conjunction with the city health department and its clinics, have adapted a new “universal treatment” initiative for our HIV clinic, effective this year, 2010. As such, we are the first in the world to begin formally recommending treatment for all our HIV positive patients, regardless of CD4 cell count, regardless of when they became infected. This new guideline is rooted in recent data from medical research that demonstrates HIV causes damage even in the earliest stages of infection, and that this damage may be reduced by shutting down HIV replication by starting medication as early as possible.
For the first 2 decades of the HIV epidemic, preventing HIV-associated opportunistic infections and cancers was the focus of therapy. Research now shows that HIV replication is also associated with increased risk of heart, liver and kidney disease, and may accelerate aging. In light of these facts, we believe the current generation of HIV drugs tips the balance in favor of early treatment in part because these drugs are much easier to take and better tolerated than earlier therapies. The benefits of early therapy now appear to outweigh the risks of ongoing HIV replication that occurs when the virus is left untreated. Our new policy, related scientific evidence, and responses were featured in an April 2, 2010 New York Times article entitled, "City Endorses New Policy for Treatment of HIV"
What does universal treatment mean? It means that we are now offering antiretroviral therapy to all of our clients unless there is a reason not to. Of course, final decisions regarding treatment are made by the patient in consultation with the provider. We estimate that this new guideline will result in offering treatment to an additional 500 patients in our clinic.
Our comprehensive care approach is designed to ensure that we support optimal adherence, provide psychosocial services and access to housing services as needed to ensure the success of therapy. We are aware of the threat of HIV drug resistance and in this regard, tailor our initial therapies to the genetic profile of the virus, and carefully monitor our patients while on treatment. We will be monitoring carefully the update of this initiative.
From a public health perspective, one of the secondary benefits of a greater number of individuals receiving HIV treatment is that HIV transmission could decrease. Recent modeling exercises and data from the public health department in San Francisco support the premise that a reduction in HIV RNA levels resulting from higher treatment rates is associated with fewer new cases of HIV infection. This premise assumes that there is no increase in HIV risk related behavior. Our clinic works hand in hand with the Prevention Division of the San Francisco Department of Public Health to implement and maximize prevention messages for our clients.
On April 13th, Dr. Mitch Katz, Director of Public Health in San Francisco and I chaired a community forum co-sponsored by Project Inform and the UCSF Community Consortium. During the forum, attended by hundreds of providers, patients and community members, and a panel of physicians and patient advocates, we announced this initiative in detail and then held an open discussion with the community, moderated by Michelle Roland, M.D., Director of the California State Office of AIDS. Thoughtful discussion among providers and laypeople raised diverse questions about policy implementation the fiscal impact that increased treatment might have on the city budget during these dire financial times. Certainly these and other open questions will arise and will require that swift and serious decisions be taken by all involved to see this through. Importantly, key figures in civic leadership are firmly committed to finding effective ways to support implementation as evidenced by the presence and participation in the forum by city supervisors David Campos and Bevan Dufty. We are proud to be establishing what we believe should be the new standard. It is perhaps a part of our legacy, a part of our heritage here at the Positive Health Program-HIV/AIDS division at San Francisco General. Ours was the first HIV-specialized clinic to open its doors to patients in 1983. Again today, we stand firmly resolute and prepared for the incredibly hard work that no doubt lies ahead, a customary condition that comes with being in the vanguard. In subsequent newsletters and online at www.php.ucsf.edu, I will continue to keep you informed of our progress with this and other initiatives designed to help save lives. With your partnership and support we can and will continue to forge ahead and be catalysts for innovation in the battle against HIV.
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