Early HIV therapy improves survival: review

Earlier is better when it comes to starting treatment for HIV, a review suggests.

In Friday's online issue of the medical journal the Lancet, British researchers concluded that waiting to start antiretroviral therapy was linked with a 28 per cent higher rate of AIDS and deaths, compared with an earlier start to therapy.

Jonathan Sterne, of the University of Bristol in the United Kingdom, and his colleagues analyzed levels of CD4 immune cells, an indicator of HIV damage, among more 45, 000 people with HIV in North America and Europe.

Doctors traditionally tried to balance the benefits of taking the medications early enough to prevent damage to the immune system while avoiding the toxic side-effects of the drugs.

Current guidelines often suggest treating when CD4 counts fall below 350 cells per microlitre of blood.

The latest study suggests waiting until CD4 levels fell to 251 to 350 was associated with worse outcomes compared with starting when levels were between 351 to 450.

"Our findings should help to guide physicians and patients in deciding when to start antiretroviral treatment," the researchers wrote.

Side-effects can be avoided more easily now since a wider range of antiretroviral medications areavailable, they said.

"It is important that people at possible risk of having HIV get tested regularly so that if found to be infected they can receive the necessary care and treatment."

But in an accompanying editorial, two experts said "the question of when to start ART might have more than one right answer," given that access to medical resources is more limited in poorer countries.

Editorial writers Dr. Robin Wood, of the Desmond Tutu HIV Center at the University of Cape Town, South Africa, and Dr. Stephen Lawn, of the centre and the London School of Hygiene and Tropical Medicine, suggested performing randomized controlled trials including people living in poor countries to update the World Health Organization's guidelines on when to start antiretroviral therapy.