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Earlier HIV Treatment Boosts Survival

Study Suggests Early Start for Antiretroviral Therapy Can Save More Lives
WebMD Health News
Reviewed by Louise Chang, MD

Oct. 27, 2008 (Washington, D.C.) -- Hundreds of thousands of lives could be saved if treatment for HIV-infected patients were started earlier than current guidelines suggest, researchers report.

The guidelines now call for initiating antiviral therapy in any person who develops symptoms of AIDS or whose CD4 T-cell count -- a measure of how much damage HIV has done to the immune system -- drops to less than 350 cells per cubic millimeter of blood.

But in a study of more than 8,000 patients, those without symptoms who started therapy when their CD4 count was between 351 and 500 cells per cubic millimeter of blood were less likely to die than those who waited until the count was lower, says Mari Kitahata, MD, of the University of Washington in Seattle.

"There was a meaningful, 70% improvement in survival among patients who started therapy when their CD4 count was between 351 and 500," Kitahata tells WebMD.

"The data strongly support initiation of antiretroviral therapy in all patients with CD4 counts of 500 or below, regardless of whether they have symptoms," she says. "We're waiting too late to treat people."

Kitahata presented the findings at a joint meeting of the American Society for Microbiology and the Infectious Diseases Society of America.

'Drug Cocktails' Cut AIDS Death Rate

Since the mid-1990s, potent drug cocktails -- called highly active antiretroviral therapy (HAART) -- have transformed HIV from a death sentence into a chronic manageable disorder, like diabetes.

But the drugs have their own set of problems. They can cause diarrhea, nausea, high cholesterol, heart problems, and other toxic effects. Skipping doses can cause resistance to develop, which means the drugs will stop working. As a result, some doctors starting delaying treatment.

In recent years, new combinations that minimize side effects and require patients to take fewer pills have become available. And research has suggested that delaying treatment can seriously damage the immune and nervous systems.

Kitahata says there's no doubt that under the current guidelines, deaths due to AIDS have dramatically declined. But the new data support growing evidence that starting treatment earlier might help cut deaths due to other causes among HIV-infected people, she says.

For the study, Kitahata and colleagues examined 8,374 people in the U.S. and Canada with CD4 cell counts of 351 to 500. Thirty percent started taking HIV drugs right away, while the others waited until their CD4 counts fell.

Dan Kuritzkes, MD, of Brigham and Women's Hospital in Boston, says the findings could lead to a change in treatment recommendations. Kuritzkes, who was not involved in the study, moderated a news conference to discuss the results.

The problem, he tells WebMD, is that patients are being tested "far too late."

Kitahata agrees. "Unfortunately, patients are coming in for treatment at a later stage of disease. Part of our message is that you need to find out your HIV status and enter care sooner so you can benefit from antiretroviral treatment."

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