A U.S. study suggests earlier start anti-HIV treatment

Highly active antiretroviral therapy (HAART) initiated early achieve a mortality rate equivalent to that of HIV-negative people, according to a U.S. study of drug addicts, which suggests, in the "Journal of Infectious Diseases" to start treatment more earlier than that advocated by the recommendations.

Clinical recommendations for treatment of people infected with HIV propose to delay the start of treatment and suggest initiate when CD4 between 200 and 350 cells /: L, but the question of the optimal time to initiate HAART remains open because there is no single answer based on the results of a controlled clinical trial.

To try to answer this question, Cunlin Wang of Johns Hopkins University in New York, and colleagues compared for the first time the mortality rate of 583 HIV-positive people on HAART than 920 HIV-negative people of the same group at risk (IDUs intravenously). Participants were followed between 1997 and 2000.

The overall survival of HIV-positive patients who initiated treatment with a CD4 count above 350 cells /: L was comparable to that of HIV-negative participants. In contrast, mortality was higher in untreated HIV + with a CD4 count above 350 cells /: L and those who started HAART with a CD4 count between 200 and 350 cells /: L.

After adjustment for age, sex, level of drug use, substitution treatment used and the utilization of health care services, the risk of death for patients who began treatment early is identical to that of HIV-negative when he is doubled for patients without treatment and in those having initiated late.

But Commencement late HAART can still significantly increase the survival rate of HIV + patients.

"The survival of HIV + patients on HAART is similar to that of HIV-negative participants, only when treatment is initiated at a CD4 count above 350 cells /: L. These data relate to drug injectors suggest that the initiation or change of antiretroviral therapy must occur at a level higher than the current recommendations CD4 count, "the authors conclude.

However, in an editorial, Dr. Mauro Schechter, University of Rio de Janeiro, is not recommended to initiate antiretroviral therapy in patients with CD4 counts above 350 cells /: L, preferring to consider the rate of fall CD4 to decide when to start treatment.

Recognizing that the work of Wang Cunlin make a "significant contribution to the debate on the optimal time to initiate treatment," Dr. Schechter believes they still have limitations. Brazilian researcher highlights include the U.S. study was not randomized, it lacks data on adherence to treatment and the comparison between HIV + and HIV-group remains problematic.