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More Study Urged on Risks, Benefits of Earlier HIV Therapy

THURSDAY July 15, 2010 -- Among HIV patients with a high level of CD4 immune cells, those who aren't taking antiretroviral therapy have a moderately increased risk of death, a new study has found.

The researchers said their findings point to the need for continuing studies to examine the risks and benefits of starting antiretroviral therapy, or ART, for patients with high CD4 cell counts.

As HIV infection progresses, CD4 cell levels decrease. Currently, treatment with ART is recommended when a patient's CD4 count drops below 350 cells per microliter.

For this study, researchers examined data from 40,830 HIV patients, aged 20 to 59, in Europe and North America, who had at least one CD4 count greater than 350 cells per microliter while not taking ART. The patients were divided into four risk groups: men who have sex with men, heterosexuals, injection drug users, and those with other or unknown risk factors.

An analysis of 401 of 419 deaths revealed that the risk of death compared to the general population was 30 percent higher for men who have sex with men, 2.94 times higher for heterosexuals, 9.37 times higher for injection drug users, and 4.57 times higher for those with other or unknown risk factors.

Compared to patients with CD4 counts of 350-499 cells per microliter, the death rate was 23 percent lower in patients with counts of 500-699 cells per microliter, and 34 percent lower for those with counts of 700 cells or more per microliter, according to the study findings, which were published online July 15 in The Lancet.

"The increase in risk was substantial in injecting drug users and the heterosexual group but was small in men who have sex with men [MSM]. This finding suggests that much of the raised risk in the former two risk groups probably results from confounding by socioeconomic and lifestyle factors rather than being an effect of HIV infection itself," Rebecca Lodwick of the HIV Epidemiology and Biostatistics Group at University College London Medical School, and colleagues wrote in their report.

"The magnitude of the raised risk in the MSM group is more likely to reflect the effect of HIV itself," they noted in a news release from the journal's publisher.

"These data suggest that HIV may increase the risk of death in people who have not taken ART and have CD4 count greater than 350 cells per microliter, but any such increase appears relatively modest. Because ART might reduce the risk of death in such patients, these findings support the need for continuing studies of the risks and benefits of starting ART at CD4 counts greater than 350 cells per microliter," they concluded.

More information

The New Mexico AIDS Education and Training Center has more about CD4 tests.

Posted: July 2010


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