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Sunday, January 06, 2013

EDUCATIONAL PROGRAMS ILLUSTRATE STRATEGY FOR BOTH TREATMENT AND CONTROL OF HIV


In November 2012, the Beyond AIDS Foundation conducted continuing medical education programs in Southern California, in conjunction with the annual meeting of the Beyond AIDS membership organization, and in observance of World AIDS Day. These programs both provided state-of-the art updates on HIV treatment, and explained the role that treatment now plays in the foundation's strategy for control of HIV transmission.

A November 17 seminar, conducted at the education pavilion of Redlands Community Hospital, featured Dr. Monica Sweeney, Assistant Commissioner of Health for HIV Prevention and Control, New York City; and Dr. Peter Kerndt, Chief of STD Control for Los Angeles County. Dr. Sweeney presented the model HIV/AIDS treatment and prevention program of the New York City Department of Public Health, including massive condom distribution, widespread HIV testing, and routine linkage of persons who test positive to treatment and partner services. Identification of new infections and onset of treatment are occurring earlier, with prospects for reducing HIV incidence. These are key elements for a comprehensive HIV control and treatment strategy as recommended by the foundation and its sponsoring membership organization, Beyond AIDS.
Dr. Sweeney demonstrates poster used to promote NYC testing
Dr. Kerndt reported on a recent multi-county syphilis outbreak in Southern California, associated with lack of condom use by the adult film industry.  This association was relevant in view of the approval earlier in November by L.A. County voters of a ballot proposal to require condom use by that industry. He also reviewed the diagnosis and treatment of syphilis, including new laboratory testing technology, and the association between syphilis and HIV infection.
Dr. Kerndt explains advances in testing methods for syphilis
Two other presentations at the seminar were provided by Dr. Ron Hattis, Beyond AIDS President. Dr. Hattis reviewed the most recent national guidelines for treatment of HIV/AIDS, which for the first time recommend offering treatment to all infected persons regardless of their CD4 counts. He reviewed the evidence that effective treatment, which suppresses "viral load" (the amount of HIV virus in blood) to undetectable levels, can reduce HIV transmission by up to 96%, a concept commonly referred to as "treatment as prevention." This is a cornerstone in the recommended strategy of Beyond AIDS for controlling the HIV epidemic (see http://www.beyondaids.blogspot.com/2012/07/normal-0-false-false-false-en-us-x-none.html). However, this strategy can only be effective if infections are detected and effective treatment is instituted much earlier than has been traditional, i.e.,  before transmission occurs. Dr. Hattis also provided information and a model checklist to help providers comply with California's unique legal requirements for testing without written consent, and similar information and a checklist for performing or referring partner services.

On November 30, 2012, Hattis was the featured speaker at Loma Linda University in advance of World AIDS Day. He reviewed the history of World AIDS Day, and delivered another update on the treatment and prevention of HIV/AIDS, again explaining how early onset of treatment and following the Beyond AIDS model could reduce national HIV/AIDS incidence by at least 60%.
Dr. Hattis presenting World AIDS Day lecture at Loma Linda University
Implementation of the 2012 guidelines from the U.S. Health and Human Services Panel on Antiretroviral Treatment for Adults and Adolescents (posted on the NIH Website), and from the International Antiretroviral Society-U.S., both of which recommend treatment of all infected persons, has lagged as this aspect of the new guidelines has not been actively promoted to providers and patients. The Beyond AIDS Foundation seeks to stimulate further education for both, to hasten implementation of earlier treatment which can benefit both patients and public health.

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