Treating HIV in 2018: what the general practitioner should know

Jean-Cyr Yombi Published in the journal : May 2018 Category : Congrès UCL de Médecine Générale

Summary :

Many prevention and treatment efforts have been made since the outbreak of the human immunodeficiency virus (HIV) epidemic. It is estimated that by June 2017, 20.9 million people had access to antiretroviral therapy. Due to the efficacy of new antiretroviral therapies, HIV-infected patients have an almost normal life expectancy. HIV has become a chronic disease requiring long-term treatment, which poses new problems such as comorbidities, the accumulation of antiretroviral treatment toxicities and finally, ageing.

The optimal timing for starting antiretroviral therapy in asymptomatic people living with HIV infection was a matter for debate until 2015, when two large randomized studies (TEMPRANO and START) indisputably showed benefit of treating all HIV-infected people regardless of CD4+ cell count. Today, the management of these patients should not be limited to triple therapy. We must vigorously fight against comorbidities (hypertension, diabetes, dyslipidemias). Smoking cessation and avoiding excessive alcohol and drug consumption should be advocated. Screening for sexually transmitted infections and their treatment as well as screening for some cancers, which are more common in the HIV population, are also part of the management strategy. While it is undisputable that every HIV-infected patient must be treated, many challenges persist. Approximately 40% of HIV-infected patients are diagnosed late, when CD4 count is already low. It will therefore be necessary to improve early detection by targeting risk populations.

What does this article bring up for us?

This article provides a clear summary of what the general practitioner should know about HIV treatment in 2018.

Key Words

HIV, antiretroviral treatment, CD4, viral load