by B.J. Caldwell, Educator

When the most recent treatment guidelines came out last year suggesting that we begin HIV treatment earlier (at least when a person's CD4 count reached 500, with more than half the panel suggesting above 500) it was a continuation of a trend : treat HIV earlier. The evidence continues to mount that the early treatment of HIV disease is the best for both the person living with HIV and their long-term outcomes and quality of life; and, their HIV negative partners in relation to reducing transmission.

It is time to retire the "you may have 10 years before needing to go on therapy" counseling, something that might have been done in the past to soften the blow of someone hearing that they're HIV positive. This kind of delay is highly unlikely, and may be limited to the small fraction of patients who have very low HIV viral load and very high CD4s. With the recently released Setpoint study (Journal of Infectiousd Diseases), which was stopped early due to the results received, it shows that even in newly infected HIV+ people should they decide to defer treatment, there is a high likelihood they will need to start treatment relatively soon. Important to note that the results would have been even more in favour had the study used the new treatment guidelines of starting treatment at 500 (the study was organized in the early 2000s before the change was made)

And with the presentation of a study at the IAS Conference in Rome last year that showed that early HIV treatment (CD4 count of 350-550) prevents HIV from being passed onto uninfected partners by at least 96%, the concept of (HIV) Treatment as (HIV) Prevention has even more basis in science. It received a standing ovation from those at the conference. While Seek and Treat programs (many of which are fashioned after the BC Centre for Excellence in HIV/AIDS) have some serious challenges, including ethical and logistical ones, the science is becomming more clear: by using treatment to reduce the viral load of those with HIV in our communities (aka community viral load), there is less HIV transmission.