U.S. Global AIDS Ambassador Dr. Eric Goosby said today the Obama Administration is in the midst of a “rigorous internal discussion” on responding to the National Institutes of Health-funded study that confirmed treating HIV-positive people with antiretroviral (ARV) drugs dramatically reduces the risk of transmitting the virus.
Asked about comments from Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, in a Science Speaks blog post that it is wiser to spend more money now to treat HIV-positive patients than to continue on the present path and spend more later, Goosby said it was likely that Fauci was accurate in saying it would cost less to treat more people now because of infections averted.
“We need to prove that, though,” Goosby said at a roundtable discussion with journalists in Washington, D.C. “Pay me now or pay me later is logical, fits the data, and it would prevent new infections from occurring, prevent a person’s lifetime cost on treatment.” He also said it would reduce the number of opportunistic infections, especially tuberculosis as the HPTN 052 study results showed, which also would result in cost savings.
“We are in the midst of beginning a rigorous internal USG [U.S. government] discussion on just that question,” Goosby said. “What I’m now committed to doing is shepherding the dialogue within USG quickly so we will know what we are up against. I think this is a study that reaches the level [that] it needs to be fully looked at, needs to challenge the way we are doing business.”
He cast it as “presenting an opportunity to be more effective at preventing infections and if so, how are we trading off on that. It raises issues on prioritization… Who gets treatment first? “
Asked to explain that further, Goosby listed a number of U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) programs – orphan funding, gender-based violence work, other diseases treated off the HIV/AIDS platform, supporting medical institutions – as a way of showing the breadth and complexity of PEPFAR’s reach. He said that all of PEPFAR’s work “could be pulled” into the discussion of funding priorities – a discussion that he said could change “in a dramatic way how we distribute [funding] across care, prevention, and treatment.”
U.S. funding on AIDS, which is part of the Global Health Initiative, is under severe budget pressure, like everything in the federal budget.
Goosby, who treated hundreds of AIDS patients in the early days of the epidemic, was asked what he as a physician would recommend to an HIV-positive patient today in light of the study results showing that ARV drugs reduce the risk of transmitting the virus to HIV-negative sexual partners by more than 96 percent.
“As a physician, your responsibility is to the patient in front of you,” he said. “That is always true, every time, you are always going to be doing what is in the best interest of the patient. …The decision whether to treat someone with ARVs also is a public health decision. It may not be in a patient’s best interest to do that. … There is a patient responsibility but what you’re really asking is, ‘What is the public health responsibility of the doctor?’”
Goosby said that even with the study results he might not advise a patient with a CD4 count above 500 to go on ARVs because of the side effects of many of the drugs and the limited benefit to a person’s health. “It’s a tricky question,” he said.
Asked whether it would be in the patient’s best interest not to infect another person, Goosby had a quick reply:
“A condom would do that.”