More pressure is likely to be placed on government drug funder Pharmac to pay for early prescribing of anti-HIV medications after the results of a major HIV treatment study were released at the just-concluded HIV conference in Vancouver. Results from the START study (see link below) showed significant health benefits of earlier initiation of HIV treatment immediately after diagnosis, regardless of the state of an individual’s immune system or health. START is the first large-scale randomized clinical trial to establish that all individuals with HIV have a considerably lower risk of developing AIDS or other serious illnesses when they begin treatment right away after diagnosis. For decades NZ clinicians and Pharmac have batted backwards and forwards the trade-off between cost and benefits of earlier starting of various HIV medications. Currently Pharmac has accepted in principle that early anti-retroviral treatment is best but funding medications for that early start has not yet been prioritised. So a threshold CD4 count of 500 remains in place for starting treatment. Another long-term study highlighted at Vancouver, called HPTN-052, has shown "dramatic and durable reductions in transmission” of HIV by those who start treatment early and whose infectivity is as a result greatly diminished. The new data “confirms the significant Treatment as Prevention benefit” to early treatment a conference report says. "New Zealand will want to move before the World Health Organisation sets a new policy,” says Body Positive chair Ashley Barratt who attended the conference, “but presumably the CD4 threshold will go. I don't think New Zealand will want to be too outside the norm in terms of the science coming out.” UN AIDS has said early access to HIV medications is a human right. Barratt believes there hasn't been enough public discussion around the Treatment as Prevention issue in this country. We don't seem to be able to have a Treatment as Prevention conversation. Dropping the overall community HIV viral load is something the NZ AIDS Foundation will have to address.” Barratt is one of those who have for some time expressed disquiet at the NZAF's reluctance to embrace the issue. Two down-sides of early start to treatment are the cost to the public health system and the toll HIV medications take on the human body. “There was information being circulated in Vancouver which proved that whole of life cost of treatment from diagnosis is cheaper than waiting for the 500 and over level before starting.” Barratt says. “The START study has demonstrated that starting HIV treatment soon after infection is not only good for reducing risk of onward transmission, but it is also strongly beneficial for individual health,” says NZAF Executive Director Shaun Robinson. “This is great news and further supports our argument that the CD4 threshold to accessing HIV medication needs to be lifted now. PHARMAC’s clinical advisers have recommended that it be lifted but this has not been given high enough priority. We will continue to argue for priority removal of the CD4 threshold.” The NZAF has long encouraged gay and bisexual men to test regularly for HIV so they can access treatment early and reduce the likelihood of them transmitting the virus to others. “What this means for our HIV-prevention work is that we need to get high-risk guys testing more often so that they can access treatment to improve their health and reduce onward transmission. We also need to communicate accurate information around undetectable viral load while maintaining community-wide support for condom use.” Condoms still play a crucial role in preventing HIV, Robinson says, “because when someone first becomes HIV positive their viral load is very high and it is easy for the virus to be transmitted to sexual partners, especially through unprotected anal sex. Many new HIV infections in New Zealand happen while the HIV positive person is in this stage, and it is often too early for it to be picked up in a test.”
Credit: GayNZ.com Daily News staff
First published: Saturday, 25th July 2015 - 7:25pm