A new study presented Sunday at the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington suggests that people with HIV should begin antiretroviral treatment sooner than guidelines currently recommend. Delaying ARVs until patients’ T-cell counts fall below 350 nearly doubles the risk of death in the next few years when compared to patients whose treatment was started earlier, the large study finds.
“The data are rather compelling that the risk of death appears to be higher if you wait than if you treat,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which co-sponsored the study.
ARVs have helped transform HIV/AIDS from a death sentence to a manageable disease. But the drugs can cause serious side effects, and poor regimen adherence can breed drug-resistant virus. US and International AIDS Society guidelines, therefore, recommend that patients who do not yet display AIDS symptoms delay starting ARVs until their T-cell counts drop to below 350 per cubic millimeter of blood.
Dr. Mari Kitahata of the University of Washington-Seattle and colleagues studied 8,374 US and Canadian patients with T-cell counts of 351 to 500 from 1996 to 2006. Around 30 percent began ARV treatment right away; the rest followed the guidelines.
“We found a 70 percent improvement in survival for patients who initiated therapy between 350 and 500,” compared to those who waited, said Kitahata.
The study’s findings build on two other recent reports showing that people who start taking AIDS drugs while their T-cell count is above 350 have a better chance of their count returning to normal - healthy people have more than 800 - than those who start ARVs later.
However, as many as a third of people diagnosed with HIV only learn they are infected after their T-cell counts have already dropped below 350. “People are still being tested and identified way too late,” said Dr. Daniel Kuritzkes, an AIDS specialist at Boston’s Brigham and Women’s Hospital. The new study underscores the importance of earlier HIV testing and diagnosis, he said.
The study’s findings do not apply to HIV patients who also have hepatitis, kidney damage, or other medical problems, or who are pregnant. Doctors have long advised these people begin treatment as soon as they are diagnosed.
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Antiretroviral Drugs HIV/AIDS Treatment or Therapies Studies or Surveys Therapeutic Drugs Treatment
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