ARV Therapy Should Start Earlier

People living with HIV should begin antiretroviral treatments earlier than what current guidelines recommend, according to a large new study presented on Sunday, the AP/Yahoo! News reports. According to the AP/Yahoo! News, current guidelines by the International AIDS Society-USA and the government recommend that patients who are not showing symptoms of the virus delay treatment until their CD4 T-cell counts drop below 350 per milliliter of blood.

Physicians traditionally have delayed antiretroviral treatment for HIV patients to avoid the treatment's side effects, which can include heart and cholesterol problems, diarrhea, nausea and other conditions. Robert Schooley, infectious disease chief at the University of California-San Diego, said, "There was this thinking, maybe the drugs were worse than the disease. If you could wait as long as you possibly could wait, you would have fewer side effects."

The new study, however, shows that a treatment delay can nearly double the risk of death in the next few years. The study's findings were reported at a conference held by the American Society of Microbiology and the Infectious Diseases Society of America. The National Institute of Allergy and Infectious Diseases helped provide funding for the study (Marchione, AP/Yahoo! News, 10/26).

For the study, researchers led by Mari Kitahata of the University of Washington examined information in the International Epidemiology Databases to Evaluate AIDS, a global network of HIV clinics from 1996 to 2005. Researchers looked at records for 8,374 healthy HIV patients with CD4 counts of 351 to 500 who had never taken highly active antiretroviral treatments. Thirty percent of the patients began antiretroviral treatment, and the remainder delayed treatment until their CD4 counts dropped below 350. The study shows that the patients who delayed treatments were 71% more likely to die during the course of the study period than those who began treatments early (Reuters, 10/26).

Schooley, who helped write the current guidelines for AIDS treatments and acts as a consultant for several companies that make antiretroviral drugs, said the new study and others like it "have all shown the same thing -- that we were starting too late" and need to continue treatments when they have been started. "The data are rather compelling that the risk of death appears to be higher if you wait than if you treat," Anthony Fauci, director of NIAID, said (AP/Yahoo! News, 10/26). He added that treatment guidelines committees are "certainly going to look hard at these data next time they meet" (Sternberg, USA Today, 10/27).