Effectiveness of antiretroviral therapy causing 'complacency' among high-risk groups

HIV/AIDS clinicians and scientists have been "witness to a transformation in disease management that is virtually unprecedented in the history of medicine," Mark Wainberg, director of McGill University's AIDS Centre at Jewish General Hospital, and Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS, write in a National Post opinion piece.

According to the authors, antiretroviral drugs "now enable HIV-[positive] individuals to survive indefinitely with good quality life." However, an "unintended consequence" of the development of antiretrovirals has been to "convince thousands of members of vulnerable populations that an [HIV-positive] status may not be harmful," they add.

According to Wainberg and Montaner, numbers of AIDS-related deaths have "drastically dropped" since the introduction of the first successful antiretroviral regimens in the mid-1990s. Yet it "now appears as though these successes may be responsible for growing numbers" of new HIV cases among injection drug users, men who have sex with men and other vulnerable groups, they note.

The authors write that HIV/AIDS experts should "confront the reality" that achievements in antiretroviral therapy have led to "complacency in regard to high-risk sexual behavior that, in turn, has resulted in steep rises in numbers of new cases." They add, "Clearly, we have to do a much better job in regard to public health, if we are to have any chance at limiting the spread of HIV."

In addition, some "physicians now often proclaim that HIV disease has been converted into a chronic manageable condition and that the use of [antiretrovirals] to prolong life is akin to the use of insulin by diabetics or anti-hypertension medications by people at risk of coronary disease or stroke," according to the authors.

According to Wainberg and Montaner, one way to address this issue is to "make sure that vulnerable individuals understand" that antiretrovirals might not "work as well as we would like them to." Although the drugs are effective at blocking replication of the virus, there is "growing evidence" that HIV-positive people are more susceptible to a number of cancers and other conditions that are "rare in the general population," they write.

Wainberg and Montaner add that the "most likely explanation" for this evidence is that the virus causes "irreparable damage to the immune system, weakening natural surveillance systems that defend against cancer." They conclude, "Perhaps it is fear of cancer and not HIV itself that will encourage people at risk to desist from high-risk sexual behavior and lead over time to reductions in numbers of new cases of HIV transmission" (Wainberg/Montaner, National Post, 5/15).