Earlier Treatment of HIV Could Help HIV-Positive People Avoid Long-Term Complications, Recommendations Say

A panel of the International AIDS Society-USA in the Aug. 6 issue of the Journal of the American Medical Association issued new recommendations for when doctors should begin antiretroviral treatment for patients with HIV, AFP/Google.com reports. The recommendations also were presented Sunday at the opening of the XVII International AIDS Conference in Mexico City (AFP/Google.com, 8/3).

Under previous recommendations, doctors delayed antiretroviral treatment until CD4+ T cells were nearly depleted and the body could no longer fight off infection from other illnesses because physicians wanted to keep the virus from developing resistance to treatment (Lauerman/Pettypiece, Bloomberg, 8/3). Usually doctors would begin treatment when CD4+ T cell counts reached fewer than 200 to 250 cells per milliliter of blood. Those recommendations were issued 12 years ago, when antiretrovirals were first introduced, treatment failure was common and there were few available treatments (AFP/Google.com, 8/3).

IAS-USA said those recommendations should be overhauled because there are now a greater number of more effective, less toxic drugs. The authors, led by Scott Hammer, an AIDS researcher at Columbia University, wrote, "The substantial toxicity and inconvenience of early regimens dampened enthusiasm for starting therapy at higher CD4 counts." They added, "However, newer regimens are potent, durable and less toxic."

IAS-USA recommended that doctors begin antiretroviral treatment when CD4+ T cell counts reach 350 copies per millileter of blood, though patients with heart, liver or kidney disease might require earlier treatment (Bloomberg, 8/3).

According to the researchers, benefits of earlier treatment of HIV include lower incidence of lung, anal, head and neck cancers; cardiovascular disease; and kidney and liver dysfunction (AFP/Google.com, 8/3). The organization's recommendations were based on a trial of more than 5,000 patients that ended last year that showed the advantages of starting treatment before the virus progresses (Bloomberg, 8/3).

The IAS-USA recommendations also could prompt doctors to combine recently approved drugs, including raltegravir, maraviroc and etravirine, with combination with older treatments to keep down viral levels and boost CD4 counts, AFP/Google.com reports.

According to AFP/Google.com, the IAS-USA recommendations are intended for high-income countries and "selected" middle-income countries where good diagnostic infrastructure and multiple drug options make it relatively easy for physicians to treat HIV-positive people.

In addition to less funding, low-income countries often have a smaller range of treatment options and lack the means to determine if a patient is responding to drugs. However, the researchers said the "core principles" of the IAS-USA guidelines are applicable to developing nations and provide ways to make treatment and patient monitoring simpler and less costly. "Progress with antiretroviral roll-out in the developing world is encouraging, but recent advances in the highly resourced world need to be adapted and translated to the developing world to realize these benefits," the researchers added (AFP/Google.com, 8/3).

The recommendations are available online.

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