Positive Life NSW Blog

Immediate or Early – what’s the difference?

Posted by on in Treatments

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Positive Life describes the difference between 'early' start and 'immediate' start to HIV treatment and the benefits of starting treatment at the time of diagnosis.

We’ve known for some time that HIV is doing damage from the time you become infected with HIV. Today we also know treatment for HIV is your best course of action to benefit your health in the long run and prevent the onward transmission of HIV to your partners.

For the large majority of people living with HIV (PLHIV), treatment for HIV is a daily single pill with no to minimal side effects. Gone are the days of handfuls of pills, specific timings and gruesome side-effects. The main debate and consideration today is when to start treatment – immediate or early? So, what’s the difference between immediate treatment and early treatment?

‘Early’ treatment is usually defined as starting treatment within six months of diagnosis. The definition of ‘immediate’ treatment is as soon as you receive a diagnosis.

In December 2016, Positive Life took the position, supported by our members, that 100% of diagnosed people living with HIV in NSW are offered the chance to start treatment the same-day or ‘immediately’. This would mean whether diagnosed in a GP setting or a hospital clinic, you would be able to walk into a nearby pharmacist to pick up a free ‘starter-pack’ of basic HIV medication and immediately gain some sense of control over your health. The diagnosing doctor would offer this option in the understanding that you can choose to ‘opt-out’ from taking the medication or even delay starting treatment as long as you wish.

Despite this clear mandate from the positive community, the timing of treatment commencement is informed by a number of concerns and issues.

Some of these concerns are around the issues of making sure the newly diagnosed PLHIV have made an informed decision about starting treatment. The last thing clinicians want to see are people who have felt ‘rail-roaded’ into starting treatment or who haven’t had time to think about what it might mean for them to have HIV. Positive Life agrees with this caution and we know the majority of PLHIV at this point of diagnosis who want to take some kind of action around protecting their health and the health of their partners.

Other issues raised are about waiting for the results of blood test results to guide the best treatment options for PLHIV. These will take up to two to four weeks and include results of the viral load, CD4 count, resistance testing for the best drug combination to use. In that window of two to four weeks, many people have told us that at that moment of diagnosis, they want to actively do something about the news now they’re living with HIV. A basic starter-pack can help PLHIV get your head around the diagnosis while providing a sense of control. When the blood test results are back, if the medication needs to be changed that’s a straightforward process.

The evidence from the Strategic Timing of Antiretroviral Treatment (START) study is clear and compelling about immediate treatment. Immediate treatment means you reduce your risks of developing other opportunistic infections, you give your immune system as much help as possible to stop the HIV virus from replicating in your body and treatment immediately controls progression of the HIV virus. The sooner you start treatment, the better position you’ll also be in to get involved in a cure when this becomes available. With any other infectious disease or STI, treatment is immediate and it’s common sense that HIV be treated in a similar way.

To discuss your HIV diagnosis and options for treatment with a peer (someone living with HIV), contact the Treatments Officers at Positive Life NSW by calling (02) 9206-2177.

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Guest Saturday, 04 April 2020

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