Early anti-HIV drugs save lives

Fri April 10th, 2009

Patients with HIV should be started on antiretroviral treatment sooner than current guidelines suggest, according to British experts.

Researchers in the "When To Start Consortium", led by Professor Jonathan Sterne of Bristol University, UK, say that combination antiretroviral therapy has substantially reduced morbidity and mortality in HIV infected individuals since its introduction in 1996.

But they believe that the CD4 cell count at which antiretroviral therapy should be started is "a central, unresolved issue". CD4 cells are targeted by HIV, and lower levels are more dangerous, leaving the immune system vulnerable to infection.

In the absence of randomised trials, they analysed results of 18 long-term studies including 45,691 patients with HIV.

These results showed that "deferring combination therapy until a CD4 cell count of 251-350 cells per millilitre was associated with higher rates of AIDS and death than starting therapy in the range 351-450 cells per millilitre".

In the Lancet, they report that the risk was 28 per cent higher when treatment was delayed. "The adverse effect of deferring treatment increased with decreasing CD4 cell count threshold," they add.

"Our results suggest that 350 cells per millilitre should be the minimum threshold for initiation of antiretroviral therapy."

They suggest that patients and doctors balance the benefit of treatment with the inconvenience and side-effects such as nausea, diarrhoea, and headache. It also brings a risk of "serious toxic effects including redistribution of body fat, hepatitis, renal failure and mitochondrial toxicity, and an increased risk of cardiovascular disease".

But they add: "These toxic effects are to an extent avoidable through choice of drug regimen."

When To Start Consortium. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies. The Lancet, published online April 9, 2009.

Tags: UK News | Flu & Viruses

Printer friendly page