Experts from UCSF, the San Francisco AIDS Foundation, Project Inform, and San Francisco General Hospital are convening a World AIDS Day town hall forum on Monday, December 2, at 6:30 p.m. at the LGBT Community Center to update the community on progress toward achieving the goal of getting San Francisco to zero new HIV infections. Getting to zero is the global theme and objective, and San Francisco has always been a leader in the global fight.
Getting tested for HIV regularly and starting treatment is a major part of the effort to get to zero. Four years ago, the UCSF HIV/AIDS Division at San Francisco General Hospital became the first program to recommend that patients start antiretroviral medications immediately upon diagnosis with HIV. Within a few months, the San Francisco Department of Public Health embraced the policy, making the same recommendation for all HIV patients in San Francisco: start treatment as soon as possible after infection. Now, United States national guidelines recommend this approach.
What are the rationales for early treatment?
First, improvements in medications have made them easier to tolerate, so side effects are much more manageable. Second, we now know that from the moment of infection, HIV damages the immune system; providing therapy earlier provides the best chance of restoring CD4+ cells. Third, HIV infection increases the risk of damage to organs such as the heart, which becomes more pronounced as patients age. Getting the virus controlled and suppressed as soon as possible reduces this risk.
In addition, case reports from the Visconti Cohort in France reveal that 14 patients who were diagnosed with HIV shortly after infection and then started on drugs immediately have been "functionally" cured. These patients went on medications for three and a half years and have been off the medications for over seven years. Very low levels of virus are detectable in their bodies. Some believe that as many as 5 to 15 percent of HIV-infected patients who start treatment within a short time of becoming infected will be able to achieve a similar medication free functional control of HIV. So getting tested regularly and treated immediately gives patients a shot at avoiding a lifetime of pill-taking and almost certainly makes future HIV cure strategies more likely to succeed for them.
Another benefit of early treatment is that patients with HIV whose virus is suppressed below the level of detection in their blood are much less likely to infect their HIV-negative partners. An important study of couples found that the HIV-infected partner was 96 percent less likely to infect their HIV-negative partner if their virus was suppressed.
Key questions the World AIDS Day town hall will address are: Four years later, what has been the impact of the change in treatment guidelines in San Francisco? And what other steps are being taken to move the needle in reducing new infections?
Encouraging individuals at risk to regularly test for HIV and, if infected, start medications is just one arrow in the quiver. Highly innovative initiatives to take us closer to our goal are under way. SFGH recently launched a program "RAPID" that provides immediate treatment for persons acutely infected with HIV. The San Francisco AIDS Foundation is opening its new home for health and wellness for gay and bisexual men located in the heart of the Castro neighborhood. It "will establish an innovative model for the current and future response to HIV/AIDS �" one built around health and wellness, not sickness and disease. It will combine a forward-thinking sexual health clinic, behavioral interventions for substance use and mental health, and grassroots prevention outreach to ensure gay and bi men in San Francisco are seamlessly linked to and maintained in care services and community support," foundation officials said in a news release.
Some medical advances are adopted quickly, while others languish �" even though they can help people. Project Inform is working diligently to make the use of a daily antiretroviral to prevent infection in HIV-negative people who have trouble using condoms a "fast idea," instead of a slow one. PrEP, or pre-exposure prophylaxis, has been shown to be over 90 percent effective in preventing HIV infection in people who use it as directed; meaning a dose every day. Increasing awareness of this important HIV prevention tool, encouraging people who can benefit from using it to do so, and protecting their right to chose it, are key tasks for Project Inform.
These and other novel projects will be discussed along with an update on the numbers recently reported by the health department. The needle is moving, but much remains to be done. As a community, we can get to zero. Join us this World AIDS Day.
The San Francisco LGBT Community Center is located at 1800 Market Street. San Francisco Supervisor Scott Wiener represents District 8, which includes the Castro; Dr. Diane Havlir is chief of the UCSF Division of HIV/AIDS at San Francisco General Hospital and Trauma Center.