U.S. Leads Slow Race to Bring Tx to HIV Patients

The improvement was more gradual in high-income countries, and the average still remained below 300 cells by 2009, he said.

The recent advent of “treatment as prevention” might have persuaded more people to seek treatment earlier, which could change the picture substantially in the next few years, Egger said.

The study highlights slow progress in getting people with HIV into care, according to Andrew Carr, MD, of the University of New South Wales in Sydney, who was not part of the study, but who chaired the CROI press conference.

“We’re doing a better job, but we’re not doing a good enough job,” Carr told MedPage Today, “and a lot of the improvement is in the developing countries.”

HIV-2 Infection in the United States

Nearly all cases of HIV infection in the United States are due to HIV-1. Reports of HIV-2 infection are rare. The first known case was a West African woman identified in 1987. Through June 30, 1995, 62 persons had been identified with HIV-2 infection. Of the 62 HIV-2-infected individuals, 9 were born in the United States, 42 in Africa, and 2 in Europe; for 9 individuals, the nationality was unknown. Of the 9 U.S. natives, 6 were adults of whom 4 had traveled in West Africa or had a sex partner from West Africa; 3 were infants born to women of unknown national origin. A 1996 serosurvey of 832 patients at a New York hospital that serves a community with a high percentage of West African immigrants did not find any HIV-2 infections that were confirmed by Western blot analysis.) In 1998 the third HIV-2 antibody-positive blood donor was reported. This person was a native of an HIV-2 endemic country. Thus, HIV-2 infection in the United States continues to be quite rare and is still largely seen in persons from West Africa or who have had sexual contact with Africans.

Screening of blood donors from 1987 through 1989 failed to identify any persons with HIV-2 infection. The CDC tested 31,533 clients from STD clinics, drug treatment centers, and HIV testing sites for HIV-2 and found only two seropositives (0.006%); both were male, heterosexual, and black. Beginning in 1992, the Food and Drug Administration recommended that whole blood and blood components be screened with combination HIV-1/HIV-2 enzyme immunoassays. Screening of blood and plasma donors from 1992 to 1995 detected the first two cases of HIV-2 infection among potential donors. One potential male donor was born in France, had lived in western Africa, and had been vaccinated in Africa with needles wiped with cotton between patients. The second potential donor was female, born in the United States, had not traveled out of the country, denied injecting drug use, and had no known sexual partners born outside of the United States.

A key question is what proportion of patients start therapy according to guidelines, which vary from country to country, Carr said. Although the starting mark is lower in the poorer countries, they appear to be doing better at reaching it, he added.

The study had support from the NIH and the U.K. Medical Research Council. Egger did not report any financial conflicts.

Carr reported financial links with Abbott, Bristol-Myers Squibb, Gilead, Pfizer, Merck Sharp & Dohme, and Viiv.

Primary source: Conference on Retroviruses and Opportunistic Infections
Source reference: Mugglin C, et al “Immunodeficiency at the start of ART: global view” CROI 2012; Abstract 100.

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