3. Promoting HIV Testing in Diverse Populations
Timing of Initiation of HAART
Since the widespread use of HAART began
in the mid-1990s, HIV clinicians have debated what the optimal time to initiate antiretroviral therapy should be. The continuing challenge has been to strike a balance between suppressing viral
replication and improving patient’s immunologic health on the one hand
and minimizing the risks of serious adverse effects on the other. In recent years,
clinical guidelines have increasingly moved
in the direction of recommending initiation
of therapy at higher CD+ cell counts. This is where an important intersection arises between treatment guidelines and encouraging routine HIV screening—HIV-positive individuals whose condition is identified earlier can be offered an opportunity to start HAART, thereby improving their own health, reducing the risk of further HIV transmission, and reducing their communities’ overall viral load.
The capsule version of the benefits associated with incorporating HIV testing into routine medical care includes the following advantages:
- Identify a larger number of HIV-infected individuals
- Diagnose individuals at an earlier stage in HIV progression
- Improve access to clinical care and prevention services
- Preserve immune function in HIV-positive patients
- Reduce rates of HIV transmission
- Reduce stigma attached to HIV testing and diagnosis
- Improve efficiency of clinical staff resources
The following paragraphs provide further discussion of these important benefits, beginning with summaries of the most commonly used clinical guidelines for initiating HAART in treatment-naive patients, along with selected supporting clinical and epidemiologic evidence.
