A large team of international researchers has found 30 percent of HIV positive individuals in nearly a dozen countries delay starting life-saving drugs.

A study spearheaded by the U.S. Centers for Disease Control and Prevention looked at the prevalence of HIV in Haiti, Vietnam, Nigeria, Namibia, Swaziland, Zimbabwe, Mozambique, Tanzania, Uganda and Zambia.

Investigators reviewed more than 694,000 treatment records from 2004 to 2015, from nearly 800 clinical facilities, focusing on patients age 15 and older.

HIV expert Andrew Auld, Malawi Country Director at the CDC, is lead author of the study.  He said in eight of the countries, the percentage of people receiving early treatment increased, in Haiti, Mozambique and Namibia by 40 percent or more during the time period.

But Auld said treatment is still not reaching a significant portion of HIV positive people.

“So some of the key things that still need to be done in these countries to further reduce the prevalence of advanced disease and HIV treatment initiation are to scale up testing strategies and facilitate HIV diagnosis at earlier disease stages, and also treatment policies that mean that patients once they are diagnosed are eligible to start HIV treatment the same day,” he said.

HIV infects and destroys the immune system’s CD-4 T-cells, so the body gradually loses its ability to fight off infections, eventually with lethal consequences in untreated individuals.

Ambitious target

UNAIDS has set a 90-90-90 target in dealing with the HIV epidemic.

By 2020, it’s hoped that 90 percent of all people with HIV will know their status, 90 percent will receive antiretroviral therapy and 90 percent of those receiving treatment will have viral suppression.

Not only does immediate antiretroviral treatment mean avoiding life-threatening complications, Auld said it reduces the risk of transmission.  

Another study, published in the New England Journal of Medicine in 2016, found treatment reduces the risk of spreading HIV to a sexual partner by up to 96 percent.  The risk of vertical transmission, from pregnant women to their newborn babies, is also reduced if the mother is treated with antiretroviral drugs.

Despite advances in treatment and care of people infected with the AIDS virus, the NEJM article noted that there were more than two million HIV infections reported worldwide in 2014.

Auld said the main reason people wait until they are very sick to go for treatment is they are unaware that quick action increases their chances of survival.

Men with more advanced cases, according to Auld, point to work demands that keep them from seeking treatment earlier in the course of the disease.  For women, childcare and family obligations are often cited.  Among infected children, Auld said the problem is access to testing and treatment.

“HIV diagnosis is not a death sentence,” he stressed.  “Excellent HIV treatment is available and people can live long, healthy, productive lives if they adhere to the HIV treatment.  And it will increase demand for both testing and treatment services.”

The study by Auld and colleagues is published in the journal Morbidity and Mortality Weekly. 

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