July 23, 2012 -- People should start taking anti-HIV drugs as soon as they test positive for the AIDS virus, according to new guidelines from the International Antiviral Society-USA.
It's a much earlier start to antiretroviral treatment (ART) than advised by current guidelines from the World Health Organization (2010, now under review), or the European AIDS Clinical Society (2011).
These guidelines suggest treatment should start only when HIV has destroyed enough of the immune system to make a person vulnerable to infections and cancers. The lab marker used to determine when treatment should start is the CD4 T-cell count.
Things began to change late last March, when a panel convened by the U.S. Department of Health and Human Services quietly changed its guidelines. The new HHS guidelines advise the same early treatment start announced yesterday at the International AIDS Conference by IAS-USA panel member Melanie A. Thompson, MD.
"Antiretroviral [anti-HIV] therapy is recommended and should be offered to all persons with HIV regardless of their CD4 T-cell count," Thompson said at a news conference.
Why Start So Soon?
An overwhelming body of research shows that HIV infection immediately starts destroying a person's immune system. This increases the risk of heart, kidney, liver, and brain disease. It also increases the risk of cancer and other diseases not usually thought of as AIDS-related.
And there's another reason. ART can drop the level of HIV in a person's blood to undetectable levels. In a recent clinical trial, people on ART were 96% less likely to infect their sex partners with the AIDS virus.
"I as a scientist look at the data and it tells me if you have viral load below detectable levels, it is extremely unlikely you will spread the infection," long-time AIDS doctor and researcher Anthony Fauci, MD, PhD, director of the National Institute for Allergy and Infectious Diseases, said at the news conference.
But Fauci notes that "it's not a slam dunk." Important issues need to be resolved. Not the least of these issues is the threat to a person's health -- and to public health -- if a person with HIV doesn't take ART as prescribed, every day for the rest of her or his life.
A patient's readiness to commit to daily, lifelong treatment is vital to the success of early treatment. Too few doses of ART make the virus resistant to even the most powerful anti-HIV drugs. The spread of such viruses has long been feared. So far, however, only 15% of HIV-infected people in the U.S. (and 11% in Europe) carry resistant virus, and that percentage has been the same for a long time.
The organization also recommended the best starting treatment regimens, and offered guidance on the best treatment strategies for people who have and who have not undergone antiretroviral treatment.
The IAS panel has no link to any drug manufacturer. Panel members accept no industry-sponsored activities, including consultations or lecture offers, from drug makers during their tenure.
The recommendations appear in the July 25 issue of JAMA.