Georgia has proposed adopting new guidelines that recommend starting HIV drug treatment as soon as patients are diagnosed, rather than waiting years for their immune systems to grow weak. AIDS researchers have said that the new approach, called “treatment as prevention,” reduces the amount of virus in the blood and can make transmission less likely, lowering the number of new cases.
Dr. Patrick O’Neal, state director of health protection, called the new guidelines “a major change from prior years.” He expects them to be in place in the next several months. According to O’Neal, Georgia’s HIV infection rate is among the nation’s highest, regularly ranking between 4th and 6th for new HIV and AIDS cases per year. More than 40,000 Georgians are HIV-positive, and the state sees an additional 1,200 HIV infections and 750 AIDS cases each year.
Treating people earlier is considered cost-effective because it can delay progress to AIDS and reduce the need for expensive hospitalizations. Scientists now know that HIV is damaging the body even before symptoms appear, said Diane Havlir, a professor of medicine at the University of California-San Francisco. Also, today’s HIV drugs are better tolerated, making early treatment more feasible.
Concerns include costing taxpayers more up front. Also, for 55 percent of HIV-positive Georgians, the state has no record of the regular lab tests needed to monitor progress. Treatment providers think this may be due to treatment costs and the lack of care in some poor and rural areas.
O’Neal acknowledged that earlier treatment could increase the waiting list for federally and state-funded HIV drug assistance. “If the guidelines are changed so that more individuals qualify for receiving drugs, then yes, we would expect greater cost to the state unless the federal government provides additional funds,” he said. He estimated the additional cost of treatment for all the new cases at $10.4 million a year. Medicaid costs may also increase.
The new Georgia guidelines will not be mandatory, but past guidance has been widely accepted.
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