The goal is reducing viral load. Viral load means the number of copies of the virus per millilitre sample of blood. Uncontrolled viral load can be in the millions. With early and effective treatment, most people with HIV will achieve suppressed or undetectable viral load.
Suppressed means under 350 copies (a threshold defined by the WHO). Undetectable means unable to be detected by current testing equipment.
When viral load is suppressed or undetectable:
Regular monitoring. To monitor the effectiveness of HIV treatment, regular blood tests are done. These include viral load and the CD4 count — a measure of the impact of the virus on the immune system. Initially patients may have these tests every 3 months, but after some time this may be yearly.
Australia has national goals for treatment. Because treatment is prevention, Australia’s National HIV Strategy has three goals:
The diagnosis you are about to deliver contributes to the first goal. You have a vital role to play in achieving the second and third goals. The achievement of these goals has already contributed to significant drops in HIV infection rates.
Keeping patients in care. Taking time and giving a good diagnosis can help motivate patients to commence treatment and remain engaged with care.
Some patients need ongoing support to take medication regularly, and this is important to prevent the virus in their system developing resistance. Regular monitoring is needed in order to detect when resistance has developed. When this happens, the treating physician will prescribe a different drug combination.
What about side effects? The potential for side effects and beliefs about the toxicity of HIV medications are common concerns for patients. It is important for you as a GP to understand and emphasise that HIV treatment has changed enormously since the early days of the HIV crisis. We now have many different options for HIV treatment, and if your patient experiences side effects, their HIV treatment physician can offer a different combination to try.
Late diagnosis. The longer a person has to wait to be diagnosed and to start treatment, the more impact HIV can have on their immune system. Late diagnosis is defined as diagnosis after a person has under 350 CD4 cells. A low CD4 count at the time of commencing treatment means a worse prognosis. The earlier a person starts HIV treatment, the better their prognosis.