July 27, 2010
Compared to the general population, persons with HIV infection have a higher risk of premature death even before their immune system deteriorates to the point at which doctors have traditionally begun antiretroviral treatment (ART), a new study shows. The analysis is based on data for 40,830 patients ages 20 to 59 in 23 countries in the European Union and North America.
The pooled cohort observational study provides further evidence that ART should begin earlier, rather than delaying it until the immune system has deteriorated significantly. A CD4 count of 200 cells/microliter or lower increases the chance of infections and AIDS-related illnesses. Yet in the developing world, treatment has generally begun only when the count falls to 200. UNAIDS recently adopted a strategy of initiating ARVs when CD4 counts reach 350 or lower.
The study focused on ART-naive HIV patients with at least one CD4 count greater than 350. Adjusting for other mortality risks, untreated heterosexual patients were nearly three times as likely to die prematurely as uninfected peers. Injection drug users were more than nine times as likely to die, and those with unknown/other risk factors were 4.5 times as likely to die. For men who have sex with men, the risk was 30 percent greater.
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