Earlier HIV Treatment Could Save Lives Worldwide
MONDAY July 20, 2009 -- Beginning antiretroviral therapy soon after an HIV diagnosis should be standard care for all, including those in poor nations where cost is a barrier, new research contends.
An estimated 76,000 deaths could be prevented and 66,000 infections avoided over a five-year period, the researchers say, if antiretroviral therapy (ART) were started when CD4 T-cell levels drop below 350 per microliter of blood instead of delaying until levels fall below 250. Their study is reported in the Aug. 4 issue of Annals of Internal Medicine.
"The time has come to act on the information we now have, nearly all of which supports starting treatment earlier," said study co-author Robin Wood, director of the Desmond Tutu HIV Centre at the University of Cape Town in South Africa, in a news release about the study. South Africa currently has the highest rates of HIV infection in the world.
Because ART is expensive and can have significant side effects, World Health Organization treatment guidelines issued in 2006 suggested waiting until CD4 counts drop below 200 per microliter of blood or until people developed AIDS-related complications. The CD4 count reflects immune system function.
In developed nations, including the United States, ART is typically started when the CD4 count drops below 350, according to the study. Applying a similar standard in countries with limited financial resources would save lives and be cost effective, the researchers say.
The study estimated the cost at $1,200 per year of life saved.
"While those standards accommodate the limited resources and short supply of medications in many settings, the greater prevalence of tuberculosis and other opportunistic infections in places like South Africa argue for earlier treatment initiation, even before the results of ongoing clinical trials are known," said the study's lead author, Dr. Rochelle Walensky, of the division of infectious disease at Massachusetts General Hospital in Boston.
The researchers used mathematical modeling to simulate HIV treatment and calculate the possible health and economic outcomes. The model determined the additional costs of earlier treatment, potential toxicities and benefits. It also looked at the cost-effectiveness of earlier ART initiation.
Posted: July 2009