Treating AIDS Infection Immediately Might Stall Immune Decay

Study results presented Feb. 9 at the 16th Conference on Retroviruses and Opportunistic Infections in Montreal found significant benefits may be associated with treating patients immediately following HIV infection.

In August, the International AIDS Society recommended that HIV patients start antiretroviral (ARV) treatment when the level of CD4 immune cells drops below 350 copies per milliliter of blood, which can take months or years after infection and varies among patients. But some recent studies have suggested ARVs should be started earlier. A study last year found that HIV-infected people live longer if treatment is started when CD4 levels drop to 500 copies per milliliter.

In the new study, Radjin Steingrover of Amsterdam's Academic Medical Center and colleagues divided patients into two groups. Fifty-five patients received six to 15 months of treatment, beginning in the early stages of HIV. This group progressed to needing long-term treatment in an average of 45 months. Another group of 47 patients who did not receive early treatment progressed to the point of needing long-term treatment after 32 months, the investigators reported.

"Until now, the benefits [of early treatment] to the patient have just been theoretical," said Peter Leone, a University of North Carolina AIDS expert and medical director of the North Carolina Department of Health's HIV branch, who was not involved in the research. "Now we've got some idea that there's benefit to the individual."

A second study presented at the conference showed that HIV patients live longer when treated even before CD4 levels drop below 500 copies per milliliter, rather than waiting until they reach lower levels. Mari Kitahata of the University of Washington-Seattle and colleagues found the risk of death from any cause was 60 percent higher in patients who waited to get ARV treatment.

A third study, led by Jonathan Sterne of the research group When to Start Consortium, looked at patients treated along a spectrum of CD4 levels. It found that HIV patients lived longer or took more time to progress to AIDS when they were treated earlier.

The challenge, said Leone, is finding newly infected patients. Most HIV infections are diagnosed by the presence of antibodies responding to the virus, proteins that do not appear until a few weeks after infection takes place. North Carolina is the only US state that routinely uses a testing method that looks for HIV's genetic material, which takes only a few days, he said.

The studies show that "with our crude tools we may be able to slow the progress of the disease. It suggests that there's an opportunity to do more, if we have more research on what's going on in this early period of infection," said Leone.

Back to other news for February 2009