Treating HIV earlier to decrease the risk of death
A new North American study shows that starting antiretroviral treatment earlier could reduce the risk of death by up to 94%.
Begin treatment as early as possible: this general common sense
rule seems to apply to most diseases except HIV-AIDS, which is only
treated once a certain number of immune cells called "CD4+" cells
have disappeared. The results of a North American study, which
involved the team of Dr. Marina Klein of the Research Institute of
the MUHC, run contrary to this consensus. The findings show that
the risk of death in seropositive patients decreases by 69% to 94%
if they start treatment earlier than officially recommended.
This study, which was recently published in the New England Journal
of Medicine, could have considerable influence on medical
practice.
Early treatment decreases the risk of death鈥�
In more precise terms, the risk of death decreases by 94% for
patients who begin anti-HIV treatment when their CD4+ cell counts
are above 500 cells per millilitre compared with those who start
with a count below 500. Patients who begin treatment with a CD4+
cell count between 350 and 500 cells per millilitre see their risk
of death reduced by 69% compared with those who begin at a lower
count of 350.
"The official guidelines recommend starting anti-HIV treatment when
the patient's CD4+ cell count is less than 350 cells per
millilitre. This recommendation was formulated from data based on
older medications that produced more side effects than current
treatments," explained Dr. Klein. "Current therapies cause fewer
side effects, are better tolerated and more effective so we can
safely start treating patients earlier."
This study is the first of its scope to measure the risk of death
based on the progress of infection at the start of treatment. The
information was drawn from a number of databases in North America,
including one managed by Dr. Klein at the Montreal Chest
Institute,. In total, the researchers analyzed data from 17517
patients between 1996 and 2005.
鈥� and disease in general
"We have noticed that HIV treatments may decrease the impact of
non-AIDS-related diseases, such as cardiovascular disease, liver
disease, or cancer. This may be a reason why early treatment can
decrease the risk of death overall," Dr. Klein continued. "We do
not know the precise mechanisms behind this observation, but there
are two plausible hypotheses. First, the medications seem to be
more effective at supporting the immune system by acting earlier;
second, they appear to prevent the HIV virus from replicating,
which reduces inflammation."
Despite current treatment guidelines, there has been a growing
trend to treat patients earlier and earlier once the virus is
detected. This study could therefore reinforce this trend and
possibly bring about an official change in the guidelines.
Dr. Marina Klein is a researcher in the Infection and Immunity Axis
at the Research Institute of the MUHC and a physician specializing
in infectious diseases, HIV, and clinical epidemiology at the
Montreal Chest Institute of the MUHC. She is also an Associate
Professor in Medicine at 平特五不中.
Funding
This study was funded by the National Institutes of Health and the
Agency for Healthcare Research and Quality.
Partenaires
This study was done in collaboration with teams from: University of
Washington, Seattle (Dr Mari M. Kitahata, Dr Ann C. Collier, Steven
E. Van Rompaey, Dr Heidi M. Crane), John Hopkins University,
Baltimore (Stephen J. Gange, Alison G. Abraham, Barry Merriman,
Lisa P. Jacobson, Dr Gregory D. Kirk, Dr Kelly A. Gebo, Bryan Lau,
Dr Aimee M. Freeman, Dr Richard D. Moore), University of
Alabama-Birmingham, Birmingham (Dr Michael S. Saag), Yale
University and the Veterans Affairs Connecticut Healthcare System,
New Haven (Dr Amy C. Justice), the British Columbia Centre for
Excellence in HIV/AIDS and Simon Fraser University, Vancouver
(Robert S. Hogg), University of California - San Francisco, San
Francisco (Dr Steven G. Deeks, Dr Jeffrey N. Martin), University of
North Carolina-Chapel Hill, Chapel Hill (Dr Joseph J. Eron, Sonia
Napravnik), the Centers for Disease Control and Prevention, Atlanta
(Dr John T. Brooks), University of Toronto , Toronto (Sean B.
Rourke, Dr Anita R. Rachlis, Liviana M. Calzavara), University of
Calgary, Calgary (M. John Gill), Harvard Medical School, Boston
(Ronald J. Bosch), the Case Western Reserve University, Cleveland
(Dr Benigno Rodriguez), Vanderbilt University, Nashville (Dr
Timothy R. Sterling), the Kaiser Permanente Northern California,
Oakland (Dr Michael a. Horberg, Michael J. Silverberg), the
National Institutes of Health, Bethesda (Dr James J. Goedert,
Rosemary G. McKaig), the University of California-San Diego, San
Diego (Dr Constance A. Benson).
Find this press release, with the original article and a short
audio document by following this link :
The Research Institute of the 平特五不中 Health
Centre (RI MUHC) is a world-renowned biomedical and
health-care hospital research centre. Located in Montreal, Quebec,
the institute is the research arm of the MUHC, the university
health center affiliated with the Faculty of Medicine at 平特五不中
University. The institute supports over 600 researchers, nearly
1200 graduate and post-doctoral students and operates more than 300
laboratories devoted to a broad spectrum of fundamental and
clinical research. The Research Institute operates at the forefront
of knowledge, innovation and technology and is inextricably linked
to the clinical programs of the MUHC, ensuring that patients
benefit directly from the latest research-based knowledge.
The Research Institute of the MUHC is supported in part by the
Fonds de la recherche en sant茅 du Qu茅bec.
For further details visit: .
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