New Research Backs Early HIV Therapy
Study Shows Early Treatment of HIV-Positive Patients Has Lifesaving Benefits
April 29, 2009 -- Starting HIV treatment earlier greatly improves survival, researchers report in this week's New England Journal of Medicine.
The finding is likely to spark a new debate over the benefits and drawbacks of early HIV therapy vs. deferred treatment.
Since the introduction of the first antiretroviral therapy more than 20 years ago, the optimal time to begin HIV treatment has been a matter of great controversy. Recommendations have wavered between an aggressive early therapy and a more cautious approach.
Proponents argue that antiretroviral drugs greatly benefit patients, and newer ones are safer and more effective than ever and do not need to be taken as often as in the past. Opponents say long-term use of such medicines can cause serious toxic effects on the heart, kidney, liver, and other parts of the body. It may also lead to drug resistance.
Many doctors recommend starting therapy in patients without symptoms when the level of CD4+ cells, a type of white blood cell, drops below 350 cells per cubic millimeter. CD4+ cells, also known as T-4 or T-helper cells, are produced by the body's immune system. They normally help fight infections. However, HIV damages the body's immune system; the number of CD4+ cells in the body drops as an HIV infection gets worse.
Comparing Early Treatment to Delayed Treatment
Until now, well-controlled studies comparing early treatment to deferred treatment have been lacking. For the current study, Mari M. Kitahata, MD, of the University of Washington Medical Center in Seattle, evaluated more than 17,000 HIV-positive patients who had never received treatment and grouped them according to their CD4+ counts at baseline:
- Those with a CD4+ count of 351 to 500 cells
- Those with a CD4+ count of more than 500 cells
The team further divided the groups into two subcategories and compared their risk of death:
- Early-therapy group: Treatment began before the CD4+ count dropped below 350. Patients in this group were mostly white men and slightly older than those in the other group.
- Deferred-therapy group: Patients waited to start treatment until their CD4+ counts dropped below 350.