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Patients should start HIV drugs as early as possible, study finds

May 28, 2015 at 6:25 PM EDT
Federal health officials now say that individuals with HIV should start antiretroviral drugs as soon as they are diagnosed. That announcement was made after a large clinical trial was stopped because the evidence was so overwhelming. But how do you get those drugs to patients who need them around the world? Dr. Anthony Fauci of the National Institutes of Health joins Judy Woodruff to discuss.
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JUDY WOODRUFF: For more than two decades, doctors have been trying to pinpoint when is the right moment to start people diagnosed with HIV on antiretroviral drugs. The drugs have been extraordinarily important in extending life and keeping HIV at bay. But they can be expensive and difficult to tolerate.

Now federal health officials say individuals should be put on those drugs as soon as they are diagnosed or learn they are infected. The announcement was made after a large clinical trial was stopped because the evidence for the drugs was so overwhelming.

Even so, that presents a bigger problem. Fewer than 40 percent of adults around the world get the drugs they need.

We look at this with Dr. Anthony Fauci of the NIH, whose institute sponsored the trial and made the announcement.

Dr. Fauci, welcome back to the NewsHour.

DR. ANTHONY FAUCI, National Institutes of Health: Good to be with you.

JUDY WOODRUFF: So, it’s been known for some time that it was important to get these drugs to people diagnosed with HIV. Why is this new finding that it’s essential to do it early different?

DR. ANTHONY FAUCI: Well, because it’s a definitive clinical trial by — quote — “expert opinion” or common practice.

We all knew that it was good to start early to benefit the person, but policies of when you’re going to recommend starting therapy and policies, everywhere from WHO to the PEPFAR program to the Global Fund…

JUDY WOODRUFF: WHO, the World Health…

DR. ANTHONY FAUCI: The World Health Organization.

JUDY WOODRUFF: Right.

DR. ANTHONY FAUCI: A definitive decision to say you should start people on therapy as soon as you know they’re infected.

It doesn’t matter what their CD4 or the level of their immune response is, because it’s highly beneficial. We kind of thought that, but we didn’t know for sure. Now we know that it’s absolutely certain that if you start earlier rather than waiting until the immune system starts to lessen in function and get a little bit damaged, that’s not a good thing, that people do much, much better when you start them off early.

JUDY WOODRUFF: Right.

In layman’s terms and very quickly, what is it that the trials showed that wasn’t clear before?

DR. ANTHONY FAUCI: Right. It was very clear.

It was called a randomized trial. It showed that if you take people who are infected with high CD4 counts and you either…

JUDY WOODRUFF: CD4 being the…

DR. ANTHONY FAUCI: Being the level of the lymphocyte that indicates the level of your immune function.

JUDY WOODRUFF: Right.

DR. ANTHONY FAUCI: If you start them right away vs. waiting until the time they get down to a certain level, which is the currently recommended level to start therapy, who does better, the ones who wait or the ones who get started right away?

And without the doubt, the study showed definitively that starting right away is of great benefit to the person.

JUDY WOODRUFF: Well, we mentioned in the lead-in to this that this discussion has been going on for some time about access, not only who can tolerate, but certainly the expense, the availability. How much urgency does this add to that argument?

DR. ANTHONY FAUCI: Well, this adds a degree of scientific rationale, scientific basis, evidence basis to make a difficult decision, because it’s going to cost resources. We’re going to have to be much more aggressive in seeking out people, voluntarily testing them, getting them linked to care, and getting them on therapy.

That’s not easy. But if you’re going to make a policy decision to do that, you want to do it based on solid scientific data, and that’s the reason why the community is viewing this trial as being so important, because it gives a firm scientific reason to make an important policy decision.

JUDY WOODRUFF: So who is going to bear the responsibility now for coming up with the funds, coming up with the resources to make this happen?

DR. ANTHONY FAUCI: It’s going to be a global thing.

For example, I mean, this is a global pandemic. There are now 36 million people living with HIV. The majority of them are in developing worlds, sub-Saharan Africa. So there are going to be countries involved. It’s going to be programs like the President’s Emergency Plan for AIDS Relief, the WHO with their recommendations.

If the WHO comes out now and makes a recommendation that you should start everyone as soon as you find out that they’re HIV-infected, that would be an incentive for individual countries to modify their policies, their health policies in their own country, because, in certain places, they won’t pay for the antiretroviral if it’s given at a certain level.

So now, if the recommendation is, it’s of great benefit to someone to start very early, that’s a very important incentive for a variety of groups, countries, organizations, or what have you.

JUDY WOODRUFF: How much pressure does it put specifically on the U.S., on the U.S. government to do more, or does it?

(CROSSTALK)

DR. ANTHONY FAUCI: Well, I think it does.

I wouldn’t say in the sense, Judy, that it puts pressure, but any decision-making, when people sit down and say what are we going to do vis-a-vis the recommendation, you want some really solid scientific basis. So if good science and good evidence is pressure, then it’s pressure.

JUDY WOODRUFF: And so at this point, what do you do in your position at NIH? What happens now to get the word out? You’re doing a news interview, but what else do you have to do?

DR. ANTHONY FAUCI: Yes.

Well, what happens now is that this is already now widely known, because the networks in the community of people who take care of patients are very, very excited about this finding. It will be published in a high-ranking journal. I’m not exactly sure which one, but you can sure it’s one of the best journals, medical journal. And then it will be just disseminated, that information.

JUDY WOODRUFF: And the hope is that people who have HIV — and we said earlier 60 percent of them are not on the drugs?

DR. ANTHONY FAUCI: Right.

We’re hoping that this will be a solid scientific foundation and basis to push to get people on therapy much earlier, not only to save their own lives, but when you put someone on therapy, you lower the level of virus such that it makes it very difficult for them to infect others.

So you get a twofer for it. You help someone’s health, and you prevent them from infecting others.

JUDY WOODRUFF: Dr. Anthony Fauci, we thank you.

DR. ANTHONY FAUCI: Good to be with you.

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