A new study by
researchers from the Centers for Disease Control and
Prevention and the University of Colorado adds more
confusion to the question of when HIV-positive people
should start antiretroviral therapy. Although most
physicians now hold off on prescribing the drugs until
their HIV patients have low CD4-cell counts or very high HIV
viral loads, the new study says that starting
treatment earlier produces better long-term results.
The study showed
that AIDS-related deaths, incidence of HIV-related
opportunistic infections, and adverse drug-related side
effects were all lower in patients who started
treatment when their immune systems were still intact.
better in almost everything we looked at," Kenneth
Lichtenstein of the University of Colorado told Reuters
Health. "If you stayed on treatment and started
earlier, you had the best outcomes."
guidelines recommend delaying anti-HIV drug treatment until
CD4-cell counts drop below 350 cells per milliliter of
blood, HIV viral levels climb above 100,000, or both.
Many even wait until CD4-cell counts drop below 200,
the clinical threshhold for an AIDS diagnosis. The delay
is mostly to avoid drug-related toxicities for as long as
possible, say researchers. But Lichtenstein's
study of more than 2,300 HIV patients from eight U.S.
cities found that those who started antiretroviral
therapy with CD4-cell counts above 350 were 60% less likely
to experience such toxicity issues as kidney problems
and lipoatrophy and 30% less likely to develop
peripheral neuropathy as those who started treatment
with CD4-cell counts of 200 or lower.
say their findings show there is no reason to delay
starting antiretroviral treatment or to delay being tested
for HIV to catch infection in its earliest stages.
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