HIV Treatment Can Be Started Later
Sticking With Treatment More Important to HIV Survival Than Start Time
Nov. 17, 2003 -- HIV treatment can be started later than
thought, say researchers. But there are stipulations.
A new study shows that HIV-infected adults who complied with
the strict drug regimens of HIV treatment had similar survival rates,
regardless of the state of their immune system at the start of treatment.
HIV progressively attacks a person's immune system, making it
harder to fight off illness. Doctors currently use blood tests that measure
immune function, specifically the CD4 cell count, along with tests that measure
the level of the virus in the blood to monitor people infected with HIV.
Current guidelines call for initiating HIV treatment when CD4
counts are less than 200. However, researchers say it's unclear whether or not
starting HIV treatment before CD4 cell counts drop below those levels would
The timing of HIV treatment is a critical clinical question
because patients must balance the risks for disease progression with premature
drug resistance, side effects, and potentially life-threatening toxicities.
Previous studies have shown that only HIV patients with immune
cell counts below 200 were at increased risk for disease progression,
regardless of the amount of virus in the blood. But researchers say those
results may have been muddled by not taking patient adherence to the strict
drug regimen associated with HIV treatment into account.
Adherence Vital to HIV Treatment
In this study, published in the Nov. 18 issue of the Annals
of Internal Medicine, researchers looked at whether the CD4 cell count at
the time of starting HIV treatment or sticking to treatment was more closely
linked to survival rates.
Researcher Evan Wood, PhD, and colleagues followed more than
1,400 HIV-infected adults in Canada on HIV treatment.
The study showed that patients with CD4 counts above 200 who
refilled their drug prescriptions regularly had lower death rates compared with
those with similar immune function levels who did not fill their drug
In fact, survival rates were similar among HIV patients that
adhered to HIV treatment regardless of whether drug treatment began when there
CD4 levels were between 200 and 349 or more than 350.
Researchers say their findings show that patient nonadherence,
rather than the timing of when HIV treatment is initiated, may be the strongest
determinant of patient survival.