Treatment
Lohse N, Hansen AB, Gerstoft J, Obel N. Improved survival in HIV-infected persons: consequences and perspectives. J Antimicrob Chemother. 2007 Sep;60(3):461-3.
A human immunodeficiency virus (HIV) patient in 2007 has the option to commence an antiretroviral regimen that is extremely efficacious in suppressing the virus and has few side effects. In a recent study, Lohse and colleagues estimated the median remaining lifetime of a newly diagnosed 25-year-old HIV-positive person to be 39 years. The prospect of a near-normal life expectancy has implications for the people living with HIV as well as for the handling of the disease in the healthcare system. Patients can now on a long-term perspective plan their professional career, join a pension plan, and start a family. Further, they may expect to be treated equally with other members of society with respect to access to mortgage, health insurance, and life insurance. As the infected population ages, more patients will contract age-related diseases, and the disease burden on some individuals may even come to be dominated by non-HIV-related conditions that may have a worse prognosis and therefore become more important than HIV-related conditions. Despite the improvements in antiretroviral therapy, there is still an excess mortality among HIV patients, which appears to be only partially attributable to immunodeficiency, with lifestyle factors potentially playing a pronounced role. Consequently, an effort to further increase survival must target risk factors for both HIV-related and -unrelated mortality. The continuation of the positive trend may be achieved by increased HIV testing, earlier initiation of antiretroviral therapy, improved drug adherence, prevention and treatment of HIV-unrelated co-morbidity, and collaboration with other medical specialists to treat an ageing co-morbidity-acquiring HIV population.
Editors’ note: In Denmark, the estimated median remaining lifetime for a 25 year old person living with HIV has increased from 8 years in 1995-96 to 23 years in 1997-99 to 33 years in 2000-05. In the absence of hepatitis C co-infection it is 39 years in comparison with 51 years for a 25 year old without HIV infection. Increased life expectancy as a result of antiretroviral therapy is highly encouraging but, as pointed out here, attention needs to turn to age-related illness and behavioural risks affecting prognosis.
Larsson EC, Okong P, Thorson A, Ekström AM. Antiretroviral treatment of HIV in Uganda: a comparison of three different delivery models in a single hospital. Trans R Soc Trop Med Hyg 2007 Sep;101(9):885-92.
This exploratory study examined health workers’ perspectives and the type of HIV care received in three different delivery models of antiretroviral treatment (ART) at St. Francis Hospital, Kampala, Uganda. Two of the clinics were financed by external donors and the third through out-of-pocket payments. Key informant interviews with health workers investigated potential challenges with ART care, and exit interviews with patients collected data on the care received. Despite the fact that all three clinics were located in the same hospital, services offered and quality of care varied extensively. Health staff at all ART clinics identified the lack of collaboration between different HIV programmes and low patient adherence as the main challenges. More women than men accessed ART through the externally financed programmes. These programmes provided more comprehensive care because of higher staff density and more frequent laboratory monitoring compared to the private clinic. Despite these shortcomings and the fact that prescriptions were often renewed without a preceding medical check-up at the private clinic, many chose to pay a monthly average equivalent of US$60 for ART in return for privacy and access to drugs without HIV disclosure requirements. Stigma and fear of abandonment were thought to be the main barriers for access to ART.
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