COMMENTARY

10 Changes in HIV Care That Are Revolutionizing the Field

John G. Bartlett, MD

Disclosures

December 02, 2013

In This Article

The challenge of HIV management seemed impossible up to 1996, but since then, it has been an incredible journey that no one saw coming. We now have 28 antiretroviral drugs, huge databases to assiduously track the incredible progress, an army of specialists to provide state-of-the-art care, and near-normal longevity for most who take standard treatment.

Many opine that the war on HIV/AIDS is largely over. But wait. The field of HIV science, patients, and providers never stops.

This review tabulates 10 key changes in HIV testing, clinical care, and healthcare delivery that will probably have a significant impact on where we go from here.

New Tests for Earlier Detection and Better Control of HIV

Fourth-Generation HIV Test

The new test adds p24 antigen to the HIV antibody test to permit detection of the disease before seroconversion, which is when the Western blot (WB) becomes positive.[1] This test is approved by the US Food and Drug Administration (FDA), and its use is recommended by the Centers for Disease Control and Prevention for screening patients because it can detect HIV during the early acute retroviral syndrome stage at Fiebig stage 2 -- unlike the WB results, which require waiting for 2-3 months after viral transmission at Fiebig stage 5.

Advantages of this early detection include (1) the possibility of functional cure (discussed below); (2) treatment at the time of maximum risk for transmission; and (3) the opportunity for direct entry into HIV care vs the long delay required for obtaining a positive WB result. This delay also promotes the problem that 20%-25% of patients with a positive WB never actually receive these results so their care may be delayed indefinitely.

Point-of-Care HIV Viral Load Testing

Point-of-care (POC) HIV testing has been extremely successful as a screening tool to detect HIV. Now, there is a POC CD4 count test that permits staging HIV at the site of care,[2] and it is anticipated that a POC viral load test will also be available, although the timeline for this development is unclear.

The advent of the POC viral load test permits patients to test their own viral load to facilitate HIV management in an outpatient setting, often without the need for frequent medical evaluation except to test for drug toxicity, comorbidities, and HIV-related complications. The long-term goal would be self-care akin to standard diabetes management.

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