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Starting HIV Drugs Earlier May Delay AIDS But Not Death
Date:4/18/2011

ients began treatment when their CD4 levels dipped under 0.500 X 109 cells/L or if they waited until their immune systems deteriorated more and reached below the level of 0.350 X 109 cells/L.

However, the risk of death did rise when patients weren't treated until their CD4 cells fell to an even lower level: 0.200 X 109 cells/L.

Patients were better able to stave off AIDS itself when they began treatment when their immune systems were stronger -- when they dipped below 0.500 X 109 cells/L.

In other words, starting treatment early -- when levels dip below 0.500 X 109 cells/L -- didn't seem to help patients live longer compared to starting it a bit later. But it did appear to keep AIDS from developing as quickly.

What to do?

"To fully benefit from early initiation, patients must present for medical care while their CD4 cell counts are still above 500 cells," said study lead author Lauren Cain, a research fellow at Harvard School of Public Health.

There are other issues to consider, added Henry, the commentary co-author. When it comes to available money for HIV/AIDS treatment, "the U.S. is actually a resource-poor country," Henry said, which makes it difficult to say that patients should always get the HIV drugs early. "You have to make some decisions about who you treat. In a perfect world maybe everybody should be treated. But guess what? It's not a perfect world," he added.

And in far too many cases, he said, "the decision is already made" -- patients don't go to get treated until it's too late to begin early therapy, anyway. That's because the levels of immune cells in their bodies have already dwindled too far.

More information

There's more on HIV/AIDS at the U.S. National Library of Medicine.

SOURCES: Keith Henry, M.D., director, HIV clinical re
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