Question

How effective has the US been in meeting the goals of the continuum of care?

Discuss the changes in the US HIV Treatment Guidelines and define the “clinically quiescent stages” and along with your thoughts of their impact the ability to meet the goals of the continuum of care?

Answer 1

Q.1

Latest Data Show Increase in People with HIV Who have the Virus Under Control show united states has been effective in achieving the goals of continuum of care.

A core focus of CDC’s high-impact HIV prevention strategy is to help ensure everyone living with HIV is aware of their infection; receives treatment; and ultimately achieves viral suppression — because people who achieve and maintain viral suppression live longer, healthier lives and are at extremely low risk for transmitting HIV to others. For a person to achieve viral suppression, several steps must be completed, including testing/diagnosis, receipt of HIV care, and retention in HIV care. The HIV Care Continuum shows how the nation is doing at each step, from diagnosis through viral suppression.

In July 2017, CDC published a comprehensive analysis of the U.S. HIV care continuum showing that, in 2014, of the estimated 1.1 million people living with HIV in the United States, 85% knew they were infected, and about half (49%) were virally suppressed. The analysis also details differences in HIV diagnosis, care and treatment by age, race / ethnicity, transmission route, and sex. It shows that although the United States has reached some important milestones, sustained, focused efforts are needed so that everyone living with HIV is aware of their infection and can effectively control the virus through treatment.

Q.2

The most recent update featured adjustments in several areas, including:

1. Recommended first-line regimens.Dolutegravir/lamivudine (sold as the fixed-dose drug Dovato), which was approved in April 2019, was added to the list of recommended initial regimens -- albeit with caveats that the regimen should not be prescribed in cases where the patient's viral load is above 500,000 copies/mL, they have active hepatitis B infection (or their hepatitis B status is unknown), or their genotypic testing results for reverse transcriptase are unknown. In addition, bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) has been added as a treatment option in acutely or recently infected people for whom genotypic drug resistance testing has not yet been completed.
2. Embrace of treatment as prevention.The guidelines were revised to more aggressively recommend immediate initiation of antiretroviral therapy following an HIV diagnosis, explicitly tying early and effective treatment to the elimination of sexual HIV transmission risk. The guidelines use the term "treatment as prevention (TasP)" to describe the strategy, but it is also commonly referred to as U=U, or "undetectable equals untransmittable."
3. Greater sensitivity to HIV treatment costs. Additional text has been added to walk providers through the complexities of HIV medication pricing in the U.S., including the differences between public and private health insurance options, as well as the potential impacts of cost-containment measures on patients' out-of-pocket medication costs.
4. Management of older patients. An updated section on HIV-positive adults over the age of 50 seeks to increase provider awareness of their patients' mental health needs, risk for neurocognitive issues, and the rising concerns of comorbidities, polypharmacy, and drug interactions among this patient population.

Q.3

Clinically quiescent stages::

The second stage of HIV infection is chronic HIV infection (also called asymptomatic HIV infection or clinical latency). During this stage, HIV continues to multiply in the body but at very low levels. People with chronic HIV infection may not have any HIV-related symptoms. Without ART, chronic HIV infection usually advances to AIDS in 10 years or longer, though in some people it may advance faster. People who are taking ART may be in this stage for several decades. While it is still possible to transmit HIV to others during this stage, people who take ART exactly as prescribed and maintain an undetectable viral load have effectively no risk of transmitting HIV to an HIV-negative partner through sex.