In 30 years, progress on HIV, but many still untreated
A survey of HIV-infected individuals in Massachusetts suggests that fewer than 60 percent received treatments within the first month after their diagnosis and that 16 percent still had not received any treatment within a year of being diagnosed.
The findings of the state Department of Public Health survey highlight some of the obstacles to further reducing the spread of HIV and deaths from AIDS, as World AIDS Day today marks 30 years since the disease was first described in a medical journal.
Progress has been made: What was once an automatic death sentence has become a chronic condition nearly akin to diabetes or heart disease. Two-thirds of the 1,000 participants in the survey, conducted in 2009, said they had been living with HIV for more than 10 years, and nearly three-quarters of the respondents said the amount of virus in their blood was very low or undetectable.
About 70 percent described their health as good, very good, or excellent, and only 3 percent of respondents said they were in poor health.
“Viral suppression improves health and we believe our high levels of medical care and access to medications’’ have contributed to the positive outcomes, said Kevin Cranston, director of the state Bureau of Infectious Disease.
The state survey may have painted a rosier picture than reality, however, because nearly all the respondents said they were receiving medical treatment for HIV. Some 17,000 state residents have been diagnosed with the virus, but the true number of those infected may be closer to 25,000, accounting for those who do not know they’re infected and, hence, are not receiving treatment, Cranston said.
Nationally, 20 percent of people infected with HIV do not know they are, according to a federal report released this week. It also found that three out of four infected people do not have the virus under control. More than 16,000 Americans die each year from AIDS.
Massachusetts encourages health care providers to offer HIV testing during routine physicals, but most eligible patients skip the test or are not offered it.
“Unfortunately, we’re a victim of our success with HIV treatments being so effective,’’ said Dr. Richard Marlink, executive director of the Harvard School of Public Health AIDS Initiative. “We have a new generation of adults who really haven’t known the devastation of people wasting away and dying. It’s become a treatment problem, and the complacency is very high; that’s what we’re battling.’’
There are still 40,000 new infections every year in the United States.
While infections have declined in Massachusetts - from 1,200 new infections annually a decade ago to about 600 new infections a year now - that could reverse with a dramatic cut in federal funding for HIV prevention services. Federal officials confirmed this week that the state health department would lose $2.2 million in federal funds this year, out of the $9.5 million it received last year for AIDS and HIV prevention services, according to Cranston. The federal government decided over the summer to divert funding to states seeing a rise in new infections.
One of the biggest impediments to slashing new HIV cases altogether is a lack of compliance with medication regimens. About 13 percent of respondents to the health department survey said they had stopped taking their HIV medications for more than a week during the past six months, usually not medically recommended since it allows the virus to multiply, increasing the risk of full-blown AIDS and of spreading the infection to others.
Cranston called that statistic concerning, but pointed out that those with HIV have higher rates of mental illness, substance abuse, and homelessness, making it more challenging for them to stay on their complicated regimens, which often require taking several pills a day.
“It’s a large problem, and it’s one we focus on daily,’’ said Morrigan Phillips, prevention and education coordinator at the Boston Living Center, which provides free support to 1,600 members infected with the virus. “A big part of it is stabilization: Those who have more stable daily lives are more likely to take their medications.’’