Treatment Naive

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Definition:

A person is considered to be treatment naive if they have never undergone treatment for a particular illness. In the world of sexually transmitted infections, the term is most often used to refer to HIV-positive patients who have never taken any antiretroviral therapy for their infection. People who have already taken one or more forms of HIV medication are considered to be treatment experienced.

In general, treatment-naive patients have more options for antiretroviral therapy than treatment-experienced patients. This is because doctors have little to no concern that they may have developed resistance to one or more drugs, or classes of drugs. That said, although most people who are treatment naive have many treatment options, that's not true for everyone. Sometimes people become infected with strains of HIV that are already resistant to one or more antiviral treatments. In fact, in some clinics that specialize in HIV treatment, part of the initial diagnosis includes sequencing the virus to look for any known mutations associated with drug resistance.

It's also unclear whether being treatment naive is necessary or whether it's possible for treatment experienced people to also switch to new drug regimens. Scientists and doctors do not yet agree whether people who have maintained undetectable viral loads on their current drug regimen need to have any concerns about switching to newer or simpler drug regimens - such as single tablet therapies.

Some scientists think that patients who have been continuously successful at maintaining an undetectable viral load, from the start of any treatment, are unlikely to have developed drug resistance.

Is it helpful to be treatment naive?

Although medications are often found to be more effective in treatment-naive patients, that doesn't mean that you necessarily want to postpone treatment to wait for a better option to emerge, particularly when talking about HIV treatment.

There is a growing body of research that shows how important early treatment for HIV can be in both limiting the viral reservoir and reducing some of the long-term consequences of infection.

While earlier in the history of the AIDS epidemic people were encouraged to wait to begin treatment, the reasons for that encouragement are no longer as valid. Side effects from antiretroviral medications have been greatly reduced, and simplified treatment options also make it easier for patients to remain drug compliant. Therefore, treatment is being started earlier and earlier in the course of infection, at least for patients who can afford it.

Another reason why early treatment is becoming more common is that doctors now understand that they can use treatment as prevention. Reducing an infected individual's viral load with appropriate treatment turns out to be a great way of reducing the likelihood that they'll pass their infection to others. The likelihood of transmitting HIV is heavily correlated to the amount of virus a person has in their blood.

Also Known As: treatment inexperienced, new to treatment

Examples:

Another disease for which treatment naitivity is highly relevant is hepatitis C (HCV). The situation for HCV, however, is somewhat different than for HIV. A substantial fraction of hepatitis patients will clear their infection without undergoing any treatment. In other words, their immune systems will get rid of it on its own. Therefore, some people remain intentionally treatment naive, in hopes that they may not need to undergo treatment with pegylated interferon and ribavirin. It is a treatment regimen that can be incredibly unpleasant.

The hope of being able to avoid pegylated interferon treatment has been expanding for some people because of some recent advances in hepatitis medications. Direct acting antivirals are medications that have been shown to have a lot of promise in the treatment of chronic HCV infection, and the second generation of these drugs that are coming down the pipeline look to be even more effective than the first. Therefore, some doctors and patients are postponing any unnecessary treatment until better drugs, and drugs with fewer side effects, become more widely available.

Unlike with HIV, there is not necessarily an advantage in treating hepatitis infections as soon as they are detected. Except on rare occasions where HCV is detected in the acute phases of infection, treatment is often not started until the infection has not only become chronic, but the virus has begun to have noticeable effects on a person's liver. That said, until relatively recently, it was not understood how important it is to treat HIV infections early. However, hepatitis infections have been around and recognized for much longer than HIV, and the infections are better understood.

Next: Learn about combination antiretroviral therapy or why some HIV doctors prefer to prescribe a nuc-free regimen...

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