Starting HIV Drugs Earlier May Delay AIDS But Not
MONDAY, April 18 (HealthDay News) -- New research suggests that
HIV-infected patients are most likely to stay clear of AIDS longer
if they start drug therapy when their immune systems are still
However, starting treatment earlier, compared to waiting, didn't
affect dying from AIDS.
"There wasn't a clear benefit in terms of preventing death" by prescribing the drugs before some guidelines suggest, said Dr. Keith Henry, director of HIV clinical research at Hennepin County Medical Center in Minneapolis and co-author of a commentary accompanying the study, published in the April 19 edition of Annals of Internal Medicine.
The issue of when to begin drug treatment is a hot topic in the
field of AIDS/HIV medicine. If physicians wait to begin treatment,
patients can delay the expense -- not to mention the side effects
-- of pricey anti-HIV drugs. But such delays may also give the
virus a chance to become more powerful and better able to fend off
If they're not treated with drugs, HIV-infected people almost
always go on to develop AIDS.
So when should doctors turn to the drugs? In the U.S.,
guidelines suggest that HIV-infected patients take them when the
level of CD4 cells -- an important part of the immune system --
dips below 0.500 X 10
9 cells per liter (cells/L). In Europe, the guideline
number is frequently lower -- meaning a weaker immune system -- at
under 0.350 X 10
In the new study, researchers examined how patients did when
they began drug therapy with their CD4 cells at a variety of
The study authors examined the medical records of almost 21,000
HIV-infected patients who sought treatment in HIV clinics in Europe
and through the Veterans Health Administration system in the United
States. The researchers found that the death rate was about the
same regardless of whether patients began treatment when their CD4
levels dipped under 0.500 X 10
9 cells/L or if they waited until their immune systems
deteriorated more and reached below the level of 0.350 X 10
However, the risk of death did rise when patients weren't
treated until their CD4 cells fell to an even lower level: 0.200 X
Patients were better able to stave off AIDS itself when they
began treatment when their immune systems were stronger -- when
they dipped below 0.500 X 10
In other words, starting treatment early -- when levels dip
below 0.500 X 10
9 cells/L -- didn't seem to help patients live longer
compared to starting it a bit later. But it did appear to keep AIDS
from developing as quickly.
What to do?
"To fully benefit from early initiation, patients must present for medical care while their CD4 cell counts are still above 500 cells," said study lead author Lauren Cain, a research fellow at Harvard School of Public Health.
There are other issues to consider, added Henry, the commentary
co-author. When it comes to available money for HIV/AIDS treatment,
"the U.S. is actually a resource-poor country," Henry said, which
makes it difficult to say that patients should always get the HIV
drugs early. "You have to make some decisions about who you treat.
In a perfect world maybe everybody should be treated. But guess
what? It's not a perfect world," he added.
And in far too many cases, he said, "the decision is already
made" -- patients don't go to get treated until it's too late to
begin early therapy, anyway. That's because the levels of immune
cells in their bodies have already dwindled too far.
There's more on HIV/AIDS at the
U.S. National Library of Medicine.
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