Word: kitahata
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...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...
...second study, Kitahata's team looked at patients who chose to start ART when their CD4 count was 500 or above and compared them with patients who decided to 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...
...None of these guidelines have been supported by the gold standard of medical evidence, the randomized controlled trial. And as convincing and as large as the current study is, Fauci notes that it too lacks this scientific imprimatur. In Kitahata's study, researchers followed patients as they and their doctors made their own decisions about when they would begin drug therapy. Those who chose to start early - before their CD4 counts reached 350 cells or 500 cells, for instance - may have simply been more health-conscious overall and therefore less likely to die, which could have confounded the study...
...Still, Fauci acknowledges that the sheer size of Kitahata's study gives its findings some weight. She presented the preliminary data to a government panel on HIV-treatment guidelines in February, and the results have since gotten HIV experts talking about whether waiting to begin treatment until the current threshold of 350 cells is reached is too late to improve HIV patients' survival...
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