Treatment

What Works

Provision and Access
  • Antiretroviral therapy has been successfully administered to both men and women with good adherence, good patient retention, and good clinical outcomes in resource-poor settings; results have been similar to those achieved in resource-rich countries.
Reducing Transmission
  • Providing antiretroviral treatment to people living with HIV can increase HIV prevention behaviors, including condom use.

HIV is a chronic, incurable illness requiring ongoing therapy. Antiretroviral therapy “is remarkably effective for infected persons who can receive treatment on an ongoing basis. Indeed, many people with HIV infection can now look forward to achieving undetectable viral loads and relatively normal lives and life spans – developments that were once hard to imagine… Unfortunately, only 20% of people with HIV infection in low- and middle-income countries know that they are infected, and less than a third of those who need therapy are receiving it” (Steinbrook, 2008: 886). The Millennium Development Goals include achieving universal access to HIV prevention, treatment, care and support by 2010 and to “halt and reverse the spread of HIV/AIDS by 2015.” As a recent report of the All Party Parliamentary Group on AIDS in the UK noted in July 2009, “We are not on track for either target” (All Party Parliamentary Group on AIDS, 2009: 5). In addition, all those millions of people who do get on treatment will need to continue being treated, cared for and supported for many decades to come.

Treatment for HIV begins prior to antiretroviral therapy with access to routine monitoring of HIV infection, including diagnosis of opportunistic infections, and routine testing of CD4 counts (WHO, 2009j, WHO, 2006b). Antiretroviral therapy is not curative – it suppresses but does not eradicate HIV-1 infection. Studies show, however, that ARV therapy does increase life expectancy of people living with HIV (The Antiretroviral Therapy Cohort Collaboration, 2008, Jahn et al., 2008, Chigwedere et al., 2008). Continuous therapy is important. With an interruption of therapy, the virus and risk for opportunistic infections increase, even in patients where the virus has been suppressed for long periods of time (SMART Study Group, 2006).

A recent review found that gender-specific differences in recommendations concerning initiation of therapy are not warranted (Floridia et al., 2008). An analysis of United States Food and Drug Administration (FDA) databases also found “no clinically or statistically significant gender differences” in 48-week efficacy of ART in randomized controlled trials between 2000 and 2008 (Stubbel et al., 2009).

While there may not be a need for different recommendations for initiation of therapy by gender, there are indications that certain interventions can be highly beneficial to women specifically in treatment provision and access, adherence and support, and reducing transmission.