Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
Early HIV Intervention by Dr. Rachel Baden
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Early HIV Intervention by Dr. Rachel Baden

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ARV Therapy and the Role of Early Intervention presented by Dr. Rachel Baden, Harvard Medical Faculty Physician at the Fenway Health Center community education conference: An End To AIDS - How A State Bill Can Change Everything hosted by SearchForACure.org, the Fenway Health Center, and the MA Dept. of Public Health

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  • Perhaps the best evidence that control of HIV infection is relative is from data generated from the MACS cohort in which it has been shown that within 6-12 months of primary HIV infection, the level at which virus reaches equilibrium or “set-point” is highly prognostic for how quickly or slowly a person will progress. In persons with the highest viral load set-point….
  • It is estimated that sexual transmission accounts for 32,000 of the 40,000 new infections each year. Conservative estimates based on the changes in behavior observed once people find out they are infected with HIV indicate that the 25% of people who are unaware that they are infected account for at least 54%, and potentially as much as 70%, of the new sexually transmitted infections each year. The transmission rate among those who don’t know they are infected is 3.5 times higher than for people who know about their HIV infection. The importance of getting these individuals tested and into care that includes both treatment and prevention interventions is critical.
  • These are data from San Francisco DPH demonstrating what’s being referred to as “community viral load” in log copies/mL on the X axis and new HIV diagnoses on the Z axis. Unfrotunately, no denominator data. Period was from 2004 to 2008. SF was a demonstration site in 2004-5 for verbal consent, and in 2006, went to opt-out testing. The take homes here are: 1) verbal consent was effective; 2) the community viral loads early in the demonstration were high– around 100,000 copies/mL at time of diagnosis– by 2008, the viral loads were around 15,000 copies/mL. The biologic impact of this is lower transmission rates (transmission is directly tied to types of risk behaviors and viral load). I can’t say more about this– the SF DPH is very careful to say the data are not robust enough to say they’re affecting HIV incidence yet, though the trend would suggest this.
  • These are data from British Columbia, Canada (includes Vancouver– very high HIV rates). The Canadians use an opt-out, verbal discussion testing format that started I believe in the mid 2000s. They’re finding trends similar to the SF DPH– community viral load down, getting more and more people on ARVs earlier, and the public health impact has been a persistently falling new case rate– in spite of continued high-risk behavior as indicated by the other STD rates (increasing syphilis, GC and chlamydia rates– generally used as surrogates for unprotected sex exposures).
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