By Annette M. Boyle

WASHINGTON--In 2009, only 9.2% of veterans in care had ever been tested for HIV. As of March 2012, 1.2 million veterans — 20% of the VA population — knew their serostatus.

“Now, we identify 2,000 new HIV-positive veterans every year,” said Maggie Czarnogorski, MD, deputy director of the HIV, Hepatitis and Public Health Pathogens Programs at the VA. “And, we link more than 96% of them to life-saving care with an HIV specialist within one month.”

- Maggie Czarnogorski, MD Deputy Director of the HIV Hepatitis and Public Health Pathogens Programs at the VA.

Czarnogorski attributed the dramatic increase in the number of patients tested to a decision to make HIV testing part of routine care for all veterans, an aggressive social-marketing program to raise awareness and reminders for primary-care physicians that are built into the electronic medical record.

“Our providers follow Department of Health and Human Services (DHHS) guidelines for treatment. As a result, 91% of our patients who qualify for antiretroviral therapy (ART) are on it and 84% have achieved viral-load suppression,” added Czarnogorski. Patients with CD4 counts of less than 500 cells/mm³ currentlyqualify for ART. Veterans are monitored at least quarterly until their viral loads are consistently suppressed.

New DHHS guidelines were released on March 27, in the report The Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Those guidelines recommend ART for all HIV-infected individuals, upgrading the recommendations for treatment of those with CD4 counts between 350 cells/mm³ and 500 cells/mm³, based on the results of observational studies. ART now is recommended for patients with counts above 500 cells/mm³ “based on growing awareness that untreated HIV infection or uncontrolled viremia may be associated with development of many non-AIDS-defining diseases, including cardiovascular disease (CVD), kidney disease, liver disease, neurologic complications and malignancy,” according to the new guidelines. Evidence from an observational cohort study also showed survival benefits for patients who began ART when their CD4 counts were above 500 cm/mm³, the report notes.

In a significant revision, the new recommendations add that, “effective ART also has been shown to prevent transmission of HIV from an infected individual to a sexual partner; therefore, ART should be offered to patients who are at risk of transmitting HIV to sexual partners.”

“Treatment is prevention,” said Czarnogorski. “Based on a recent study, we know treatment of infected individuals can cut transmission by 96%. Our goal is to connect HIV-positive veterans with care as quickly as possible to begin treatment and education.”

The study, Czarnogorski cited, the HIV Prevention Trials Network (HPTN) study 052, “Prevention of HIV-1 Infection with Early Antiretroviral Therapy,” was named Breakthrough of the Year by Science magazine in December 2011. The magazine’s editor, Bruce Alberts, noted that “the results have galvanized efforts to end the world’s AIDS epidemic in a way that would have been inconceivable even a year ago.”

The study, sponsored by the National Institute of Allergy and Infectious Diseases, showed that providing early ART treatment for an HIV-infected partner can nearly eliminate transmission to a noninfected partner. In addition, the study demonstrated that patients who received early treatment with ART had a 41% lower risk of adverse clinical events than those who started treatment later.