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Should doctors prescribe the medications the moment the patient tests positive for HIV or, as the U.S. government recommends, wait until the patient's immune system deteriorates to 350 CD4 cells or below?
The CD4 cells are essential parts of our immune system. The HIV virus destroys them and makes people infected much more vulnerable to terrible diseases.
This question is critical for Latinos in the United States because in 2006 - the last year for which data is available - 42% of Latinos developed AIDS within one year of testing positive for HIV. According to research shared at the conference AIDS deaths have been dropping dramatically since the advent of the medications more than a decade ago. But research has found that to fully benefit from the medications, patients need to start taking them shortly after an HIV test comes back positive.
We should not wait until the CD4 falls below 350. The operable slogan now, as one researcher told me, is "Treat early and treat hard."
The first hurdle to implementing this new treatment approach is government policy. The official guidelines from the U.S. Department of Health and Human Services' Public Health Service for American doctors is to hold off until CD4 cells drop below 350. Unless a patient's blood drops below this magic number, most are never offered the medications, and if they are they will not be covered by Medicaid.
One reason for the U.S. policy is that many of the medicines have severe side effects. But the responses from researchers at the International AIDS Conference is that HIV infected people with an immune system that is not too deteriorated are better able to tolerate the medicines. In addition, the newer drugs don't have as many harsh side effects as they did in the past.
According to another study, to be released here,most people with AIDS either stop taking their medications or never start because of actual, or rumors of, side effects such as diarrhea, rashes, psychological problems, change in looks as fat gets redistributed in the body and many more. The solutions are obvious. For the pharmaceuticals, develop more medicines that can be taken once a day for easier adherence and with few or no side effects. For public health services, change the rules that mislead doctors and insurers and can lead to a shorter life span and all kinds of severe diseases. For the community-based organizations and physicians, become educated on the new science which shows that when you start treatment right after a positive HIV test you can live a near-normal life.
Last, the doctors and community groups need to educate clients about the new findings and describe the ease of taking the medications and the near lack of side effects.
This is a tall order but necessary if AIDS is truly going to become not a death sentence but merely a chronic condition like diabetes, heart disease or herpes.
Dennis deLeon is the president of the Latino Commission on AIDS and a member of the Civilian Complaint Review Board. He is the former head of the city's Commission on Human Rights.
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