HIV-positive U.S. military personnel—all of whom receive free health care—had much higher rates of success with antiretroviral (ARV) therapy than is typically seen in the average medical practice, according to a study published May 27 in AIDS Research and Therapy.

HIV treatment success is usually defined by the ability to achieve and maintain undetectable HIV levels, while also increasing CD4 cell counts. A number of studies in countries with free access to medical care have demonstrated higher rates of treatment success than is typically seen in cohort studies in the United States. Though a number of potential explanations can account for this discrepancy, one known contributor to poor adherence treatment failure is limited access to health care.

Universal access to health care is not common in the United States, though one segment of the population does have it: military personnel. To determine rates of treatment success among HIV-positive military personnel, Vincent Marconi, MD, from Emory University in Atlanta and his colleagues examined the medical records of 2,327 military personnel who were followed at military clinics between 1996 and the end of 2007.

Marconi's team found that military personnel who began treatment in 2000 or later did exceptionally well. After one year on treatment, 81 percent had their virus suppressed to less than 400 copies. After five years, 85 percent were suppressed. Even eight years after first starting treatment, 82 percent maintained full viral suppression. The average CD4 cell increase after starting ARVs was 247. Over time, 34 percent experienced virological failure.

In contrast, an analysis of 20 clinical trials among the general population of people living with HIV found an average success rate of 76 percent and an average 176 cell increase in CD4s. Treatment success rates in U.S. cohort studies, which are closer to “real life” treatment scenarios, range from 50 to 85 percent, with up to 50 percent of people experiencing a rebound of virus within three years of starting ARVs. While it is presumed that people in these studies have at least some access to treatment and care, by the mere fact of having participated in these studies, it is unlikely that free and universal care was available to every participant.

Marconi and his colleagues acknowledge that the population of U.S. military personnel is quite different from the average U.S. population. They are generally younger, fitter and better educated. Rates of injection drug use are less than 1 percent. Moreover, the motivation to remain healthy is high among HIV-positive military personnel, who may remain in active duty status as long as they do not develop AIDS-related health conditions. Indeed, being on active duty when starting ARVs was a predictor of treatment success.

Nevertheless, the authors conclude, “These findings support the notion that free and open access to health care provides a favorable environment for optimizing HIV treatment outcomes.

For a blog entry by Tim Horn about this study, click here.