New Study Addresses “When to Start?” Question

Some recent studies have found that starting highly active antiretroviral therapy earlier is better. Now a new study led by researchers at the University of North Carolina at Chapel Hill finds that there may be a limit to how early the therapy, known as HAART, should start, according to a report in ScienceDaily on a study which is published in the September 26 issue of the journal Archives of Internal Medicine.

The new results could help determine where the starting line for antiretroviral therapy should be drawn, said Michele Jonsson Funk, PhD, research assistant professor in the UNC Gillings School of Global Public Health and lead author of the study. "The drugs used to treat HIV are expensive, treatment is life-long, and the side effects can be serious," Jonsson Funk said. "So we really need to know if the patient's investment will pay off, how large the benefit is likely to be, and how long it will take to realize it.

"The bottom line from these findings, taken together with other studies published over the last few years, is that initiating therapy when the patient's CD4 count is between 350 and 500 appears to be beneficial over the long term. But for patients with a CD4 count above 500, the jury is still out."

There is wide agreement among researchers and health-care providers that HIV patients with CD4 counts below 350 should be on antiretroviral therapy. However, there is still uncertainty regarding starting treatment at higher CD4 counts. This study was aimed at answering that question.

The researchers found slower progression of HIV among patients whose CD4 counts were between 350 and 499 when they began treatment. The findings also showed a 41% reduction in the relative risk of AIDS or death for patients who started receiving HAART with CD4 counts of 200 to 349; and reductions in the risk of death of 29% and 49% associated with HAART initiation at CD4 counts of 200-349 and 350-499, respectively. However, there appeared to be no benefit to initiating treatment at CD4 counts between 500 and 800.

The results are based on statistical analyses that Jonsson Funk and study co-authors performed on data collected from 9,455 HIV patients in Europe, Australia, and Canada between 1996 and 2009. The patients were enrolled in the CASCADE (Concerted Action on SeroConversion to AIDS and Death in Europe) Collaboration.

Dr. Joseph Eron, co-author of the study, a professor in the UNC School of Medicine and a member of the UNC Center for AIDS Research, was also a co-author of a landmark HIV prevention study called HPTN 052, which found that early treatment (CD4 count of 350-550) with combination antiretroviral therapy led to a 96% reduction in transmission of the virus to the uninfected partners of HIV-positive participants and a 40% reduction in their own risk of developing a serious illness. Those results are consistent with the results reported by Jonsson Funk.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.

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