News / Africa

Starting AIDS Treatment Much Earlier May Mean Longer, Healthier life

Multimedia

Audio
TEXT SIZE - +
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

Wikipedia Proves Useful for Tracking Flu

Technique gave better results than Center for Disease Control (CDC) and Google’s Flu Trends More

Turkish Law Gives Spy Agency Controversial Powers

Parliament approves legislation to bolster powers of intelligence service, which government claims is necessary to modernize and deal with new threats Turkey faces More

Video Face of American Farmer Changing

Average American farmer is now 58 years old, and farmers 65 and older are the fastest growing segment of the population 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.
Face of American Farmer is Changingi
X
Mike Osborne
April 18, 2014
The average American farmer is now 58 years old, and farmers 65 and older are the fastest growing segment of the population. It’s a troubling trend signaling big changes ahead for American agriculture as aging farmers retire. Reporter Mike Osborne says a new report from the U.S. Census Bureau is suggesting what some of those changes might look like... and why they might not be so troubling.
Video

Video Face of American Farmer is Changing

The average American farmer is now 58 years old, and farmers 65 and older are the fastest growing segment of the population. It’s a troubling trend signaling big changes ahead for American agriculture as aging farmers retire. Reporter Mike Osborne says a new report from the U.S. Census Bureau is suggesting what some of those changes might look like... and why they might not be so troubling.
Video

Video Donetsk Governor: Ukraine Military Assault 'Delicate But Necessary'

Around a dozen state buildings in eastern Ukraine remain in the hands of pro-Russian protesters who are demanding a referendum on self-rule. The governor of the whole Donetsk region is among those forced out by the protesters. He spoke to VOA's Henry Ridgwell from his temporary new office in Donetsk city.
Video

Video Drones May Soon Send Data From High Seas

Drones are usually associated with unmanned flying vehicles, but autonomous watercraft are also becoming useful tools for jobs ranging from scientific exploration to law enforcement to searching for a missing airliner in the Indian Ocean. VOA’s George Putic reports on sea-faring drones.
Video

Video New Earth-Size Planet Found

Not too big, not too small. Not too hot, not too cold. A newly discovered planet looks just right for life as we know it, according to an international group of astronomers. VOA’s Steve Baragona has more.
Video

Video Copts in Diaspora Worry About Future in Egypt

Around 10 percent of Egypt’s population belong to the Coptic faith, making them the largest Christian minority in the Middle East. But they have become targets of violence since the revolution three years ago. With elections scheduled for May and the struggle between the Egyptian military and Islamists continuing, many Copts abroad are deeply worried about the future of their ancient church. VOA religion correspondent Jerome Socolovsky visited a Coptic church outside Washington DC.
Video

Video Critics Say Venezuelan Protests Test Limits of Military's Support

During the two months of deadly anti-government protests that have rocked the oil-rich nation of Venezuela, President Nicolas Maduro has accused the opposition of trying to initiate a coup. Though a small number of military officers have been arrested for allegedly plotting against the government, VOA’s Brian Padden reports the leadership of the armed forces continues to support the president, at least for now.
Video

Video More Millenials Unplug to Embrace Board Games

A big new trend in the U.S. toy industry has more consumers switching off their high-tech gadgets to play with classic toys, like board games. This is especially true among the so-called millenial generation - those born in the 1980's and 90's. Elizabeth Lee has more from an unusual café in Los Angeles, where the new trend is popular and business is booming.
Video

Video Google Buys Drone Company

In its latest purchase of high-tech companies, Google has acquired a manufacturer of solar-powered drones that can stay in the air almost indefinitely, relaying broadband Internet connection to remote areas. It is seen as yet another step in the U.S. based Web giant’s bid to bring Internet to the whole world. VOA’s George Putic reports.
AppleAndroid