By: Neomi Heroux
Published: Thursday, 2 April 2009
When the AIDS epidemic began, any person with HIV present in their system was facing a death sentence. There was no treatment, there was no cure. Pharmaceutical manufacturers rose to the challenge and produced antiretroviral drugs that reduced the virus from a killer to a chronic disease.
One problem with treatment is deciding when to initiate therapy. Once treatment began the patients would have to take the drugs for the rest of their lives, and they were not without toxic consequences. Doctors and their patients had to carefully consider the right time to take action. As recently as five years ago HIV physicians would generally not recommend beginning therapy for asymptomatic patients with a CD4 blood cell count greater than 500 because of concerns about the drugs side effects.
A study released on April 1, that will appear in the April 30 issue of the New England Journal of Medicine compared patients who started treatment early, with those who delayed therapy. Lead researcher Dr. Mari M. Kitahata, of the University of Washington, Harborview Medical Center, Seattle said, “The optimal time to initiate therapy for asymptomatic HIV-infected individuals has been unclear.” The study found that those who delayed therapy increased their odds of dying by either 69 or 94 percent, depending on how low the patient’s CD4 blood cell count was.
Kitahata’s team collected data on 17,517 American and Canadian HIV patients who received treatment from 1996 through 2005. Patients were classified by their CD4 immune T-cell count. The count is a measure of the immune system. As the disease progresses the CD4 count drops. The participants were in two groups, based on their CD4 counts, one group had counts between 350 and 500 cells per millimeter the second group was patients with CD4 counts above 500.
In the first analysis of 8,362 patients, 25 percent began therapy when their CD4 counts from 350 to 500. The other 75 percent deferred treatment until their CD4 counts fell below that. The patients who deferred treatment had a 69 percent greater risk of dying compared to those who began earlier treatment.
In the second analysis of 9,155 patients, 24 percent began treatment at CD4 counts of more than 500 cells per millimeter. The other 76 percent delayed treatment until their counts fell below 500, this group had a 94 percent rise in risk of dying compared to the earlier therapy group.
Kitahata said, “Our study adds to the growing evidence that support earlier initiation of therapy to improve survival. We think antiretroviral treatment should be started when the CD4 count is above 500. I feel these data are strong enough that I would start a patient who is ready and willing to begin therapy at a CD4 count above 500 and certainly between 350 and 500.”
Dr. Paul E Sax, of the division of infectious diseases and the department of medicine at Brigham and Women’s Hospital in Boston, said that the study does seem to tilt the argument in favor of earlier treatment. It provides some of the strongest data that earlier treatment prolongs survival. The study alone doesn’t prove the point but adds to the accumulating data that earlier treatment is preferred to waiting.
\
http://www.healthnews.com/medical-updates/hiv-drug-treatment-time-is-essence-2895.htmlsoure:
