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Early administration of antiretroviral therapy can improve survival
Date:4/9/2009

ministration of the treatment difficult. With new families of drugs available and new, less toxic combinations, it is now possible to consider instating treatment earlier without unduly affecting the patient's quality of life.

The study published in The Lancet, in the framework of the Antiretroviral Therapy Cohort Collaboration, includes information from 15 international cohorts. Data were obtained from 21,247 patients who were followed up during the period prior to instatement of combined antiretroviral therapy and 24,444 patients who were followed up from the beginning of treatment. Waiting to administer the combined therapy until CD4 levels had fallen to between 251 and 350 cells/L was associated with a 28% higher rate of development of AIDS and death than beginning treatment when levels were between 351 and 450 cells/L. The adverse effects of delaying therapy were directly linked to the drop in the CD4 count. Waiting to treat until the CD4 count was below these levels was also associated with a higher mortality rate (13%), though the effect on mortality was smaller than the combined effect on developing AIDS and death.

The conclusion of the study is that the lowest level for initiating antiretroviral therapy is 350 cells/L. This will soon be indicated in the clinical guides and in clinical practice. The Gesida/National AIDS Plan guides are already being drawn up and will include the recommendation to initiated treatment before the CD4 count falls below 350 cell/L. The new recommended figure will probably be between 350 and 500 cells/L. The international clinical guides (both European and American), which will not be updated for some months, and the SMART clinical trial also suspected that antiretroviral therapy should begin before the CD4 count falls to 350 cells/L. Furthermore, the journal New England Journal of Medicine (

Contact: lex Argem
aargemi@clini.ub.es
34-932-275-700
IDIBAPS - Institut d'Investigacions Biomdiques August Pi i Sunyer
Source:Eurekalert

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