Great Article on START

Tim Horn wrote a great article on a subject we brought up a few weeks ago, START.  You can read his entire article HERE on Poz.com. To read our brief blog post, go HERE. Here is an excerpt from it.


...Early treatment may also benefit the greater good of the public health. Some research suggests that undetectable viral loads in a large swath of the HIV population can potentially slow the spread of the virus. In turn, public health officials are considering whether widespread, immediate ARV therapy could be an effective HIV prevention tactic.


Few experts and activists argue that the research supporting early treatment is anything less than encouraging. Where there is less agreement, however, is whether enough sound, scientific research has been conducted to spell out the benefits and risks—the increased (or decreased) likelihood of short- and long-term side effects, adherence challenges and the development of drug resistance, for example—of early treatment and to warrant major changes to public policy. In fact, some of the most experienced and trusted sources of HIV prevention and treatment policy are struggling to make the right call...

...

The rationale behind recommending treatment for those with up to 500 CD4s comes primarily from two large cohort studies. The North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) study and the ART Cohort Collaboration (ART-CC) study suggested that people who waited to start treatment until CD4s dropped below 350 faced a higher risk of premature death, from any cause, than people who start treatment at a CD4 count above 350.


Further evidence in support of early treatment—again from cohort studies—suggests that uncontrolled HIV replication might be associated with a number of illnesses not traditionally associated with AIDS. These include non-AIDS-related cancers, cardiovascular disease, liver disease, kidney disease and immune inflammation.

Simon Collins of HIV i-Base, an HIV treatment education and advocacy group in London, argues that these data need to be interpreted with a critical eye. Not only are the observed differences marginal, but the data reported thus far only come from studies with important limitations.

“The few studies involving patients starting at 350 and 500 show both options are very safe and very effective,” Collins says. “In [NA-ACCORD], 19 out of 1,000 people died in the first year of treatment if they started at 350, compared with 16 out of 1,000 people who started above 500. The absolute risk of death in both groups was very small. The difference in the absolute risk between the groups—0.3 percent—could easily have been due to confounding factors [factors unrelated to HIV] that [cohort study limitations] can’t account for.”

The Creation of a National HIV/AIDS Strategy in the United States

Jeffrey Crowley M.P.H.

Director of the Office of National AIDS Policy

Gregorio Millett M.P.H.

Senior Policy Advisor in National AIDS Policy

Who are these guys and how do their ideas and beliefs towards HIV Prevention going to affect us?

For as long as these gentleman have been in office, I had no idea who they were.  When you are kind of on the bottom of the chain, sometimes it's hard to see who is at the very top.  But listening in on a community input call for a National HIV/AIDS Strategy, I decided to see who these guys are who will dictate how we combat HIV/AIDS in the next few years. 

Briefly, here are the bios from the Whitehouse website for these two gentlemen.

Jeffrey Crowley 

From 2000-2009, Mr. Crowley was a Senior Research Scholar at Georgetown University’s Health Policy Institute and a Senior Scholar at the University’s O’Neill Institute for National and Global Health Law. His primary areas of focus involved Medicaid and Medicare policy issues as they impact people with disabilities and chronic conditions, including people with HIV/AIDS. Prior to this, he served as the Deputy Executive Director for Programs at the National Association of People with AIDS (NAPWA), overseeing the organization’s public education, community development, and training activities.

Gregorio Millett

He is the staff lead for the HIV interagency working group that is tasked with developing the National HIV AIDS Strategy. Prior to his position with Office National AIDS Policy, Mr. Millett was a Senior Behavioral Scientist in the Division of HIV/AIDS Prevention (DHAP) at CDC in Atlanta. In that capacity, he authored numerous peer reviewed papers that explored racial/ethnic disparities in HIV among men who have sex with men (MSM), correlates of HIV risk behavior among bisexual men of color, and the relationship between circumcision and HIV acquisition among MSM

So, are these two guys who will understand what needs to be done to combat HIV/AIDS?

Here's a VIDEO from the first meeting of the Presidential Advisory Council on HIV/AIDS where Crowley actually discusses what has been done up to February 2010 on HIV/AIDS. 

So far, the 3 main items that the Natioal HIV/AIDS Strategy will be focusing on is:

1.  Reducing the rates of HIV/AIDS infections in the US

2.  Making sure that more people who are living with HIV/AIDS is getting treatment and care.

3.  Reducing the health complications associated with HIV/AIDS

Obama has budged $3 Billion towards the prevention and treatment of HIV in the US.  There is discussion that the Obama administration will direct focus of HIV prevention in targeted communities where HIV infection is more concentrated.  The African American community is one of these populations.  Some figures that were mentioned in reasoning in addessing this community is 

1 out of 16 African American men and

1 out of 30 African American women will become infected with HIV in their lifetime.

There still seems limited amount of talk in addessing the Gay/Bisexual male community with HIV prevention messages.  I'm hoping that infections within this community is pointed out and acknowledge by this administration as the TOP priority. I especially hope Gregorio Millett takes a stand behind this given his previous work within these communities.   

What do you all think?  What are some things you hope the National HIV/AIDS Strategy will address?   

What is ADAP?

ADAP – AIDS Drug Assistance Program

ADAP are programs established by the national government to help subsidize HIV medication costs to thousands of people. ADAP is estimated to reach about one-third of all people living with HIV. For many people, these programs are necessary for affording not only their HIV medications, but to in turn, afford everything else they need to live. But because of the national recession and the enormous amount of debt some states are incurring, ADAP programs are starting to see dramatic cutbacks.


In 1987, AZT was discovered and ADAP soon followed. Although there are funds from the national government allocated to each state for their ADAP programs, a large portion still needs to be subsidized by each state. Currently, HIV/AIDS medications can cost a person from $10,000 to $20,000 a year. Many states have not been able to keep subsidizing for their ADAP programs and now have been creating waiting lists for their ADAP programs. This means that from a few to over a few hundred people are not able to obtain help in purchasing their extremely expensive medication. Luckily, Wisconsin understands the importance of providing significant funds towards these programs and we do not have any waiting lists for ADAP. Other states are not so lucky.

According to the ADAP Advocacy Association (aaa), Hawaii has the least on their waiting list with 2 people. North Carolina has the largest by far with 470 people on their waiting list. Kentucky is the second highest with 200 people. This means that all of these people are not able to get the medications they need to stay alive. And that is why AIDS Watch, a branch of the National Association of People living With AIDS (NAPWA) just had Lobby Days (April 26-28), a time where constituents from their individual States went to talk to their congress people in Washington D.C. and to encourage them to pass an emergency supplemental for ADAP .

Why is ADAP important to HIV Prevention?

Right now, and we probably will do an article on this later on, there are a few new biomedical prevention items coming out.  Two of these involve using ARV (AntiRetroViral medication).  These programs are called PEP (Post Exposure Prophylaxis) and PrEP (Pre Exposure Prophylaxis).  If there is not enough money to help those living with HIV get the medications they need, is there really enough money to give medications to HIV - people to keep them HIV-? 

The second reason is because there has been studies done that say that there is a slightly, and let me emphasis slightly, less risk contracting HIV from someone who is HIV+ if that person's viral load is lowered to "undetectable" levels through treatment. If individuals can't get this treatment, their viral loads will stay high and will greatly increase the liklihood if they have unprotected sex or share a needle, to transmit the virus.