MELBOURNE, Australia — Long-term trends indicate that European men who have sex with men are seeking treatment for HIV at earlier stages of their disease, researchers reported here.
In the first quarter of 2009, the CD4-positive cell counts were about 260 cells/mm3, but by the fourth quarter of 2013, the CD4-positive counts in men who have sex with men were about 340 cells/mm3, an indication that these men were seeking early treatment, said Samantha Fernando, PhD, research manager at Ipsos MORI, a health research company in London.
During the same period, the change in time to seeking treatment among all patients — as indicated by CD4-positive counts — barely budged, from counts of 280 cells/mm3 to 300 cells/mm3, Fernando reported in her poster discussion session at the 20th International AIDS Conference.
"Men who have sex with men seem to be more receptive because people in that community are speaking more about getting early treatment options and are asking their clinicians if they can be on a certain treatment," she told MedPage Today.
In her presentation, Fernando also illustrated that the time between diagnosis and treatment has steadily fallen since 2009 — from 32 months for all patients to 20 months for all patients, and from 30 months to 15 months for men who have sex with men.
She pointed out that there were differences in countries for men who had sex with men in the time from diagnosis to treatment: 12 months in France, 14 months in Germany, 15 months in Italy, 16 months in Spain, and 20 months in the U.K.
Fernando said that the fall in time to treatment after diagnosis "is very good news."
"Evolving HIV treatment options, guideline changes, and ‘test and treat’ policies encouraged by UNAIDS in 2010 have created a marked shift in treatment adoption," Fernando said. "Results are encouraging: the proportion of untreated men who have sex with men patients is declining, with prompt initiation of treatment at higher CD4 counts reducing the time between diagnosis and treatment."
"With men who have sex with men representing the largest population, earlier capture and treatment initiation is imperative to suppress viral load, increase treatment success, and further control HIV progression," she said.
Fernando’s study reviewed outcomes in the U.K, France, Germany, Italy, and Spain. Ipsos HealthCare’s HIV Therapy Monitor collected demographic and treatment data from 230 physicians quarterly beginning in 1995. Guideline changes were retrospectively assessed within this period.
In commenting on the study, Till Barnighausen, MD, PhD, of the Harvard School of Public Health, told MedPage Today, "There may be an alternate reason we are seeing these higher CD4-positive counts in men who have sex with men who are seeking treatment. It may be that the sickest of the men — those with the lowest CD4 counts — have already sought therapy and therefore are removed from the pool of patients who are available to seek treatment. We would then tend to see just the men with higher CD4-cells."
"Overall, though, the trends being seen in Europe are encouraging," said Barnighausen, who moderated the poster discussion session. "We would hope that these trends are being driven by behavior change. I am still a bit cautious in how to read these results."
He noted that the trend to earlier treatment is probably more pronounced in the U.S. because the U.S. has committed to treat patients as soon as their HIV status is determined.
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