Word: hiv
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There's a mantra in AIDS treatment that every physician in the field knows by heart: When it comes to HIV, hit early and hit hard...
...problem is that nobody, including the experts, knows how early is early enough. And now the largest study to date attempting to answer that question suggests that initiating anti-HIV therapy far earlier than current guidelines recommend could save more lives. The findings are setting off a lively debate in the AIDS community about whether those guidelines should be changed - and how soon...
...Mari Kitahata, at the University of Washington, reports in the New England Journal of Medicine that HIV-positive patients enrolled in a nine-year study reduced their risk of dying as much as 94% by the trial's end if they began ART earlier, compared with patients who deferred treatment. "Our study adds to the weight of evidence accumulating that the balance between the potential benefit in survival of initiating therapy earlier outweighs the potential deleterious effects," says Kitahata, referring to concerns over the drugs' toxicity and possible long-term side effects...
...Kitahata studied more than 17,000 HIV-positive patients who were being treated by physicians from 22 different research groups in 60 cities in North America between 1996 and 2005. She and her team essentially conducted two trials. In one, the scientists looked at patients who chose to initiate ART when their level of CD4 cells - infection-fighting immune cells that HIV uses to replicate and then systematically destroys - ranged between 351 and 500 cells per cubic mm of blood. These patients were compared with those who decided to defer therapy until their counts dipped below 350 cells per cubic...
...defer treatment until their CD4 counts dropped below 500 cells. (In a normal, healthy adult, CD4 levels range from 600 to 1,200.) In both studies, the patients deferring treatment were more likely to have died by the 2005 end of the study than were their earlier-treated cohorts. HIV-positive patients beginning therapy at CD4 levels between 351 and 500 cells were 69% more likely to be alive at the end of the nine-year study, while those initiating drug treatment at CD4 counts of 500 or more were 94% more likely to have survived...