Louisiana’s ADAP staff was forced to relocate; nonetheless, they immediately began to look for their clients. Texas’ ADAP worked with pharmaceutical companies and Louisiana’s Medicaid program to provide uninterrupted treatment to all evacuees. In Alabama, grantees reached out to the State department of health, community-based organizations, AIDS service organizations, and private philanthropic organizations for help, and they were able to reopen clinics after only a week. Louisiana’s grantees kept working to provide services despite damaged facilities, loss of equipment, and staff shortages. In Mississippi, grantees from destroyed sites worked from trailers.81
HRSA staff and Ryan White grantees contributed to the development of resources to help providers deliver care after catastrophic events. Recommendations for Non-HIV-Specialized Providers Caring for Displaced HIV-Infected Residents from the Hurricane Disasters were issued less than a month after Katrina hit, and by 2008, the ADAP Emergency Preparedness Guide was released. Since Hurricane Katrina, HRSA has held many trainings on the topic of emergency preparedness, including presentations at the biennial All-Grantee Meeting.
Because of treatment advances, HIV primary care doctors are now addressing all the health related conditions associated with old age.
Researchers and clinicians tried several strategies to treat people with multidrug resistance. Strategies included increasing drug levels by adding a pharmacokinetic booster; interrupting treatment, in the hope that drug-sensitive virus would rebound; initiating multidrug rescue therapy (mega-HAART), which entailed as many as nine drugs, some recycled from previous regimens; and using genotypic and phenotypic resistance testing to identify drugs likely to work.82,83,84,85
Ultimately, mega-HAART and treatment interruptions were discarded because of their inefficacy, drug toxicity, and availability of new and more potent drugs.86,87 Enfuvirtide, an injectable fusion inhibitor, was the first drug from a new class to be approved in 6 years. It provided a bridge for many people that allowed them to survive until better options were available. By 2007, several new medications were available, including drugs from novel classes (an integrase and an entry inhibitor) and second-generation PIs active against drug-resistant virus. These drugs offered hope to people who had been without treatment options, although, as Feit cautions, “There is still no treatment that is as good as not being infected.”
The value of HIV treatment was underscored by results from the Strategic Management of Antiretroviral Therapy (SMART) study. SMART compared continuous HIV treatment to intermittent therapy (guided by CD4 cell count). The study was stopped early because the results were overwhelming: Illness and death from both AIDS-related and non-AIDS-related causes were significantly higher in the intermittent therapy group than those who remained on continuous therapy.88 When researchers looked more closely at data from SMART, they observed that death rates were linked with higher levels of inflammation markers in the bloodstream and that these markers were present at higher levels in people on intermittent treatment than in those on continuous therapy.89