Patients with HIV/AIDS may live longer with early start of highly active antiretroviral therapy (HAART) in low-income countries, new research has found. The researchers of the study, published on 16 January 2010 in AIDS Research and Therapy, acknowledge the dilemma financially-constrained low-income countries face in choosing between providing HIV treatment to more patients and focusing on more severely ill patients.
"Since low-income countries have many constraints to full coverage of HAART and more people will be eligible with an early start strategy, the results of this study is a good starting point for a more transparent and reasoned debate when drawing explicit eligibility criteria during further scale up of HAART," the study's authors say.
Revised Antiretroviral Therapy Guidelines for HIV Patients
The findings of this study are in concordance with the recommendations in the World Health Organization's revised 2009 guidelines for antiretroviral therapy. The guidelines, Rapid Advice: Antiretroviral Therapy for HIV Infection in Adults and Adolescents, recommend that HAART should be initiated on all HIV-positive patients with CD4 counts below 350 per cubic millimeters, regardless of symptoms.
Several studies published in 2009 from high-income countries support even earlier initiation of treatment—before CD4 counts decrease below 350.
Delayed HAART treatment starts were previously recommended because of concerns about long-term toxicity and fear of developing drug-resistant viruses. The delayed HIV treatment policy implied that, in the absence of particular disease manifestations, treatment should not be started before CD4 counts dropped below 200.
Benefits of Early Start of HAART
Providing HAART early when CD4 count is 200-350 is likely to be the best outcome strategy with an expected net benefit of 14.5 life years per patient, according to the study. Patients starting treatment at CD4 counts 50-199 and below 50 have expected net health benefits of 7.6 and 7.3 life years. Without treatment, HIV patients with CD4 counts 200-350, 50-199 and below 50 can expect to live 4.8, 2.0 and 0.7 life years, respectively.
Recommendations for Low-income Countries
HIV treatment is still mainly provided to the sickest patients in low-income countries. Few have revised their national treatment guidelines and many still recommend delayed initiation of HAART in asymptomatic HIV-positive individuals. This study indicates that ‘hit hard and early’ treatment strategies in low-income countries may extend the life of people living with HIV/AIDS.
References:
- Johansson KA, Robberstad B, Norheim OF. Further benefits by early start of HIV treatment in low income countries: survival estimates of early versus deferred antiretroviral therapy. AIDS Research and Therapy 2010; 7: 3.
- Kitahata MM, Gange SJ, Abraham AG, et al: Effect of early versus deferred antiretroviral therapy for HIV on survival. N Engl J Med 2009; 360: 1815-1826.
- Sabin CA, Phillips AN: Should HIV therapy be started at a CD4 cell count above 350 cells/microl in asymptomatic HIV-1-infected patients? Curr Opin Infect Dis 2009; 22: 191-197.
- World Health Organization. Rapid Advice: Antiretroviral Therapy for HIV Infection in Adults and Adolescents. WHO, 2009.
Juan Ramos - Juan Ramos is a health communication specialist based in Boston, Massachusetts, USA. He has worked in the non-profit sector for more than ...
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