Q&A: Expert assesses the impact of new HIV research

Scientific researchers recently released data from a high-profile study showing that people infected with HIV, the virus that causes AIDS, were significantly less likely to transmit the virus to their partners if they were put on antiretroviral drugs immediately, when their immune systems were still relatively strong, instead of waiting for the disease to progress. A top HIV scientist at the National Institutes of Health official, Anthony S. Fauci, said the study “convincingly demonstrates that treating the infected individual-and doing so sooner rather than later-can have a major impact on reducing HIV transmission.” The Connecticut Mirror spoke with Jack Ross, an infectious disease doctor and director of Hartford Hospital’s HIV Program, about the clinical, financial, and societal implications of this new research. Below is an edited transcript of the conversation:

CT Mirror: What was your reaction to the study’s findings?

Ross: This study confirmed that there’s a huge benefit to getting people tested, getting them into care and on treatment-and that you’re going to have a 95 to 96 percent reduction in transmission to their partners. It’s a benefit to society, in terms of ongoing transmission of the virus, and a benefit to the individual… It was incredible news.

CT Mirror: Has it changed the way you treat your HIV-positive patients?

Ross: What we’re doing now is following the Department of Health and Human Services HIV treatment guidelines… But if a patient has wanted to start medication earlier, many times we say yes. What will be interesting is, will DHHS now say that anyone with HIV should be on HIV medications all the time? Many years ago, many of us would have not have favored that because the regimens were complex, the medications were hard to take, there were side effects. Now we have much better regimens, the meds are easier to take and we don’t see the side effects we used to. So many of us would favor going to universal treatment for anyone who is HIV positive.

CT Mirror: But how politically and financially feasible would it be to get all HIV-positive patients on antiretroviral drugs?

Ross: Most folks, once they’re found to be HIV-positive, they are in care, so it won’t change that part of the equation. It’s a matter of how to pay for the medications and the labs to monitor the patient. That could be difficult because of the recession and the cutbacks we’ve seen. The financial pressures people are facing include loss of insurance and increasing co-pays. And we’re seeing higher deductibles on plans where people have to meet costs right up front each year.

CT Mirror: So has Connecticut’s AIDS Drug Assistance Program worked in helping people with those costs?

Ross: For me Connecticut’s ADAP has been something I turn to when someone has had their hours cut from something like 40 hours to 32 hours, and they can’t afford their medications anymore… It’s people you wouldn’t expect. It may be a school teacher, or someone who works in a tech firm, or someone who works changing the oil in your car. They fly under the radar and they need that assistance… The HIV meds have gotten incredibly expensive. Right now, one of the new medicines is $995 dollars per month, so if you do the math that’s $12,000 a year. And that’s just one of three drugs we would use, so the total cost can be between $20,000 and $40,000 a year.

CT Mirror: If the U.S. moves to universal treatment, in which HIV positive patients are put on drugs as soon as they are found to have the virus, are there concerns about the development of drug-resistant strains of HIV?

Ross: That would be a concern because longitudinally, you have to have a patient who is willing and who knows this is a life-long commitment. Resistance will develop if they do not take their medications, so adherence becomes very important. If the patient is not ready, you would not want to start medications. You work with them and make sure they are ready… But I have to tell you I have a lot of patients who have been on that same triple therapy that came out in 1995. These regimes can be very durable, they’re very potent.

CT Mirror: What do you think of the cuts to Connecticut’s state contribution toward ADAP?

Ross: I’m not a politician. But I think it’s penny-wise and pound-foolish, because for every transmission you prevent it’s someone you keep out of care. And that means, for every case you prevent, you’re saving $250,000 to $300,000 over ten years. And by prevention, I mean testing for HIV and treating those we find to be positive. This helps not only the patient–because they get into care early–but also their partners and society as a whole.