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Starting HIV Therapy Earlier Saves Lives
Date:4/1/2009

Study casts doubt on notion that antiretrovirals can be postponed till later in infection

WEDNESDAY, April 1 (HealthDay News) -- Initiating HIV treatment before the patient's immune system is too badly compromised can dramatically improve survival, a new study finds.

The finding may help settle a debate among AIDS experts as to whether powerful antiretroviral drug therapy can be deferred until later in the infection process.

On the one hand, experts worry that starting patients early on the potent drug cocktail could increase the medicines' toxic effects. But if treatment begins too late, the drugs might not be as effective.

Because patients must continue to take these drugs for the rest of their lives, weighing toxicity against efficacy has been a difficult balance.

"The optimal time to initiate therapy for asymptomatic HIV-infected individuals has been unclear," explained lead researcher Dr. Mari M. Kitahata, of the University of Washington, Harborview Medical Center, in Seattle.

But in the new study, the Seattle group found that, compared with patients who started treatment early, patients who delayed therapy boosted their odds of dying by either 69 percent or 94 percent, depending on how low the patient's CD4 blood cell count was.

The study was released ahead of schedule April 1 by the New England Journal of Medicine. It will appear in the journal's April 30 print issue.

For the study, Kitahata's team collected data on 17,517 American and Canadian HIV patients who were receiving treatment from 1996 through 2005. Patients were classified by their CD4+ immune T-cell count, a measure of the strength of the immune system. As HIV disease progresses, the CD4 count drops.

Participants were divided into two groups: one group had CD4 counts between 351 and 500 cells per millimeter, while the other group was comprised of patients with CD4 counts above 500.


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