Many unaware of status

A significant number of people may be unaware that they are infected with the HIV virus, which represents part of the rationale for the latest CDC HIV testing recommendations, says Czarnogorski. “In 2006, CDC came out with new HIV test recommendations which lay out the argument that routine testing is warranted in any community where prevalence is greater than 0.1%,” she explains. At present, she adds, the CDC estimates 1.1 million Americans are infected with HIV, and that 21% of those individuals may not know it.

Studies have shown that those individuals who are unaware of their status are transmitting the virus, says Czarnogorski, adding that, while there is no vaccine or cure, there are “pretty excellent” antiviral treatments. “If people take them and suppress the virus – that is, get it to undetectable loads – you are 98% less likely to transmit it to others,” she notes.

With significant progress having been made since approval of the first antiviral, Czarnogorski says treatment can now be as simple as one pill a day. A TRIPLA, a combination of three different drugs (efavirenz, emtricitabine and tenofovir), is the simplest of these and the one that individuals are usually started on, she notes, although most treatment is guided by the actual patient. “There is genotype testing for the virus each individual has against all FDA-approved medications that tell us which are most likely to be effective,” Czarnogorski explains.

“We provide excellent care to those we know are HIV-positive; if you are diagnosed, 95%-99% are linked to an HIV provider within 90 days of diagnosis,” she notes. In addition, says Czarnogorski, 91% of those who qualify for antiviral therapy are on it; all 23 FDA-approved antivirals are on the VA formulary.

“We also know that, of those who are on an antiviral, 84% are virally suppressed,” she adds. “That’s almost a benchmark for the rest of the nation.”

For all of these reasons, her ultimate goal is to have all veterans tested at least once in their lifetime. Earlier detection means better care, she asserts. “Even if a patient’s CD4 count is under 200, there’s still a lot we can do for them -- but we can do much less than if they had been diagnosed earlier,” says Czarnogorski (Based on DHSS guidelines, patients should be started on antiviral therapy if their count is below 350; if it is under 500, it is up to the physician).

In fact, she says, if veterans are diagnosed in their 20s there’s no reason why they can’t live into their 80s if they get the appropriate medications. “It has become a chronic disease -- similar to diabetes,” Czarnogorski asserts.

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