News / Africa

Starting AIDS Treatment Much Earlier May Mean Longer, Healthier life

Multimedia

Audio
Joe DeCapua

Over the years, there’s been debate over when to start HIV-positive patients on anti-retroviral drugs, or ARVs.  At first the standard practice was to wait until a person’s immune system had nearly collapsed.  But a growing body of research shows there may be many benefits to starting treatment much earlier.

Measuring the number of CD4 immune cells is a major determining factor on when to begin drug treatment.  It was the norm to give ARVs to people who either had full-blown AIDS or had CD4 counts below 200.

Now it’s generally accepted that anti-retrovirals should be given when the count drops below 350.  But there’s debate over whether to start treatment even earlier than that.

Dr. Roy Gulick, Weill-Cornell Medical Center
Dr. Roy Gulick, Weill-Cornell Medical Center

The subject was discussed at the recent OPMAN XVIII, the Optimal Management of HIV Disease Conference.  

Dr. Roy Gulick, professor of medicine at the Weill-Cornell Medical Center in New York City, says, “It’s ironic that 23 years now into anti-retroviral therapy we are still asking a very basic question.  And that is, when should we start?”

Pros and cons

Gulick outlines a few reasons for starting anti-retroviral treatment early.

“We know that our treatment decreases viral load levels and thus the emergence of (drug) resistance and also increases CD4 cell counts and general immune function.  We have published data to show that our best regimens can suppress viral load levels for up to seven years or longer,” he says

What’s more, he says, “Treatment likely reduces transmission in the community.  That is, treatment can be prevention.”

Starting earlier may also be more cost effective.

Some of the reasons for delaying treatment have included the inconvenience and toxicity of anti-retrovirals and their long-term side effects.  

“On balance, up until recently, we have elected to wait to start.  But there is a lot of data, newer data, to suggest that the balance of this question is likely shifting,” he says.

There had been general agreement that ARV treatment should be started for anyone with AIDS, symptomatic HIV disease or CD4 counts less than 200.

But there’s now agreement on a second group with a higher count.

“That is asymptomatic with CD4s between 200 and 350.  The developed country guidelines all changed to a firm yes in 2008.  And the newest guidelines to now suggest this are the WHO (World Health Organization) ’09 guidelines, which now say, yes, we should be treating anyone with HIV disease, regardless of symptoms, with a CD4 (count) less than 350,” he says.

A study in Haiti helped persuade the World Health Organization to recommend starting treatment earlier.  Fewer deaths and infections were found in those who received ARVs sooner.  Besides a drop in mortality, earlier treatment resulted in fewer tuberculosis cases among patients.

“This was the data that caught the eye of the WHO and really the world and said that we should be starting earlier throughout the world,” he says.

Gulick says the shift to earlier treatment is also due, in part, to “easier, less toxic and more potent therapy.”

He says, “So we go from handfuls of 20 plus pills taken three times daily to as few as one pill once a day.”

Starting AIDS Treatment Much Earlier May Mean Longer, Healthier life
Starting AIDS Treatment Much Earlier May Mean Longer, Healthier life

There are also the findings of many cohort studies to support earlier treatment. The findings are based on thousands of HIV patients, whose progress was followed in clinics.

In 2002, in one study, no difference was seen in those receiving treatment when their CD4 counts were between 200 and 350 and those who started treatment when their counts were over 350.  At least that was the case after comparing the two groups over a three-year period.

“Although there’s no difference at three years,” he says, “at five years, this now reaches statistical significance.  So, there was a benefit to starting earlier in this cohort study.  And it took over three years, more like five years, to convincingly show the clinical benefit here.”

Proof enough?

The professor of medicine asks if the results appear good for those receiving treatment at this stage, why not start even earlier? In other words, a CD4 count above 350.  Some cohort studies seem to support this, but Gulick says those studies are not always enough to go on.

“Well, what’s the problem with all the data I’ve shown you so far?  And that is it’s not randomized clinical trial data.  These are cohort patients.  That is, general patients followed in clinics,” he says.

And these patients may be different.

“It’s safe to say that patients who elect to start ART (anti-retroviral therapy) with high CD4s may not be the same as patients who defer ART with the same high CD4s,” he says.

Those who choose to start treatment sooner may have better health habits.  

“They may use seatbelts more.  They may exercise more.  There may be other confounding reasons why they have general better health than the group who elects to defer.  So we have to take all this cohort data somewhat with a grain of salt,” Gulick says.

And some cohort studies found starting treatment at a much higher 450 to 550 CD4 count showed no significant benefits.

To try to settle the issue, a formal clinical study – the Start study – is now underway.  It’s enrolled patients with CD4 counts higher than 500.  The study could finally determine whether it’s more beneficial to start treatment immediately or wait until CD4s drop below 350, the current standard.  However, the results may not be known for six years.  

Some say the there’s enough data from the cohort studies to not wait for the Start study results.  

You May Like

Taliban's New Leader Says Jihad Will Continue

Top US Afghan diplomat also meets with Pakistani, Afghan officials following news of Mullah Omar's death More

Video US Landmark Pushes Endangered Species

People gathered in streets, on rooftops in Manhattan to see image highlights that covered 33 floors of Empire State Building More

World’s Widest Suspension Bridge Being Built Over Bosphorus

Once built, Yavuz Sultan Selim Bridge will span 2 kilometers with about 1.5 kilometers over water, and will be longest suspension bridge in world carrying rail system More

This forum has been closed.
Comments
     
There are no comments in this forum. Be first and add one

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Astronauts Train Underwater for Deep Space Missionsi
|| 0:00:00
...    
🔇
X
George Putic
July 30, 2015 8:59 PM
Manned deep space missions are still a long way off, but space agencies are already testing procedures, equipment and human stamina for operations in extreme environment conditions. Small groups of astronauts take turns in spending days in an underwater lab, off Florida’s southern coast, simulating future missions to some remote world. VOA’s George Putic reports.
Video

Video Astronauts Train Underwater for Deep Space Missions

Manned deep space missions are still a long way off, but space agencies are already testing procedures, equipment and human stamina for operations in extreme environment conditions. Small groups of astronauts take turns in spending days in an underwater lab, off Florida’s southern coast, simulating future missions to some remote world. VOA’s George Putic reports.
Video

Video Civil Rights Leaders Struggled to Achieve Voting Rights Act

Fifty years ago, lawmakers approved, and U.S. President Lyndon Johnson signed, the Voting Rights Act of 1965. The measure outlawed racial discrimination in voting, giving millions of blacks in many parts of the southern United States federal enforcement of the right to vote. Correspondent Chris Simkins introduces us to some civil rights leaders who were on the front lines in the struggle for voting rights.
Video

Video Booming London Property a ‘Haven for Dirty Money’

Billions of dollars of so-called ‘dirty money’ from the proceeds of crime - especially from Russia - are being laundered through the London property market, according to anti-corruption activists. As Henry Ridgwell reports from the British capital, the government has pledged to crack down on the practice.
Video

Video Hometown of Boy Scouts of America Founder Reacts to Gay Leader Decision

Ottawa, Illinois, is the hometown of W.D. Boyce, who founded the Boy Scouts of America in 1910. In Ottawa, where Scouting remains an important part of the legacy of the community, the end of the organization's ban on openly gay adult leaders was seen as inevitable. VOA's Kane Farabaugh reports.
Video

Video 'Metal Muscles' Flex a New Bionic Hand

Artificial limbs, including the most complex of them – the human hand – are getting more life-like and useful due to constant advances in tiny hydraulic, pneumatic and electric motors called actuators. But now, as VOA’s George Putic reports, scientists in Germany say the future of the prosthetic hand may lie not in motors but in wires that can ‘remember’ their shape.
Video

Video Russia Accused of Abusing Interpol to Pursue Opponents

A British pro-democracy group has accused Russia of abusing the global law enforcement agency Interpol by requesting the arrest and extradition of political opponents. A new report by the group notes such requests can mean the accused are unable to travel and are often unable to open bank accounts. VOA's Henry Ridgwell reports.
Video

Video 'Positive Atmosphere' Points Toward TPP Trade Deal in Hawaii

Talks on a major new trade agreement among 12 Pacific Rim nations are said to be nearing completion in Hawaii. Some trade experts say the "positive atmosphere" at the discussions could mean a deal is within reach, but there is still hard bargaining to be done over many issues and products, including U.S. drugs and Japanese rice. VOA's Jim Randle reports.
Video

Video Genome Initiative Urgently Moves to Freeze DNA Before Species Go Extinct

Earth is in the midst of its sixth mass extinction. The last such event was caused by an asteroid 66 million years ago. It killed off the dinosaurs and practically everything else. So scientists are in a race against time to classify the estimated 11 million species alive today. So far only 2 million are described by science, and researchers are worried many will disappear before they even have a name. VOA’s Rosanne Skirble reports.
Video

Video Scientists: One-Dose Malaria Cure is Possible

Scientists have long been trying to develop an effective protection and cure for malaria - one of the deadliest diseases that affects people in tropical areas, especially children. As the World Health Organization announces plans to begin clinical trials of a promising new vaccine, scientists in South Africa report that they too are at an important threshold. George Putic reports, they are testing a compound that could be a single-dose cure for malaria.
Video

Video 'New York' Magazine Features 35 Cosby Accusers

The latest issue of 'New York' magazine features 35 women who say they were drugged and raped by film and television celebrity Bill Cosby. The women are aged from 44 to 80 and come from different walks of life and races. The magazine interviewed each of them separately, but Zlatica Hoke reports their stories are similar.
Video

Video US Calls Fight Against Human Trafficking a Must Win

The United States is promising not to give up its fight against what Secretary of State John Kerry calls the “scourge” of modern slavery. Officials released the country’s annual human trafficking report Monday – a report that’s being met with some criticism. VOA’s National Security correspondent Jeff Seldin has more from the State Department.
Video

Video Washington DC Underground Streetcar Station to Become Arts Venue

Abandoned more than 50 years ago, the underground streetcar station in Washington D.C.’s historic DuPont Circle district is about to be reborn. The plan calls for turning the spacious underground platforms - once meant to be a transportation hub, - into a unique space for art exhibitions, presentations, concerts and even a film set. Roman Mamonov has more from beneath the streets of the U.S. capital. Joy Wagner narrates his report.
Video

Video Europe’s Twin Crises Collide in Greece as Migrant Numbers Soar

Greece has replaced Italy as the main gateway for migrants into Europe, with more than 100,000 arrivals in the first six months of 2015. Many want to move further into Europe and escape Greece’s economic crisis, but they face widespread dangers on the journey overland through the Balkans. VOA's Henry Ridgwell reports.
Video

Video Stink Intensifies as Lebanon’s Trash Crisis Continues

After the closure of a major rubbish dump a week ago, the streets of Beirut are filling up with trash. Having failed to draw up a plan B, politicians are struggling to deal with the problem. John Owens has more for VOA from Beirut.
Video

Video Paris Rolls Out Blueprint to Fight Climate Change

A U.N. climate conference in December aims to produce an ambitious agreement to fight heat-trapping greenhouse gases. But many local governments are not waiting, and have drafted their own climate action plans. That’s the case with Paris — which is getting special attention, since it’s hosting the climate summit. Lisa Bryant takes a look for VOA at the transformation of the French capital into an eco-city.

VOA Blogs