New York City pushes earlier treatment for AIDS

In an effort to halt the spread of AIDS, health officials in New York City recommended yesterday that treatment with anti-AIDS drugs should begin as soon as an individual is diagnosed with the human immunodeficiency virus (HIV), the virus that causes AIDS, rather than waiting for it to begin harming the immune system.

New York City Health Commissioner Dr. Thomas Farley sees the switch as a new way to fight the disease. As he told the Wall Street Journal, “I’m more optimistic now than I’ve ever been about this epidemic that we can drive our new rates down to zero or close to it—eventually.”

As my Harvard Health colleague Peter Wehrwein described in a post on Worlds AIDS Day 2011, drug therapy can help prevent the transmission of HIV. Using it earlier may help protect the immune system.

HIV destroys the type of infection-fighting white blood cells known as CD4 cells. As the number of CD4 cells dwindle, the body becomes more susceptible to infections. These are often infections that people with healthy immune systems fight off easily.

Some AIDS experts question the value of waiting until CD4 counts begin to dip, and recommend—as New York City officials have done—starting anti-HIV therapy as soon as the virus is detected. These drugs can’t totally rid the body of the virus. But they can keep the number of HIV particles low enough to slow down, and perhaps even prevent, destruction of the immune system.

Early treatment is especially important for people with a high number of HIV particles in the bloodstream (called the viral load). A higher viral load increases the chances of a more rapid decline in immune function. It is also a good choice for people who aren’t comfortable waiting to treat a medical problem that could be treated now. For them, early treatment could be an important psychologic boost.

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