NEJM: Early HIV therapy delays AIDS-related events & death
- For at least 20 years, there has been controversy about whether to start treament immediately or to wait until an HIV-infected patient becomes symptomatic or experiences a decrease in CD4-positive white blood cell counts to levels of 350 cells per cubic centimeter or lower.
- In a clinical study that included 4,685 HIV-positive adults, 1.8% of HIV-positive patients who received immediate treatment experienced a serious health outcome over a three-year period, compared with 4.1% of patients who delayed treatment.
- Researchers also concluded that side effects from starting therapy early were not a major problem.
While the controversy around whent to start therapy in HIV-positive patients has been ongoing for some time, new evidence being presented at the International AIDS Society 2015 Conference in Vancouver may finally be the game-changer that puts practitioners, advocates and patients on the same page: Early treatment yields the best outcomes.
There had been concerns that starting therapy in asymptomatic patients could actually worsen outcomes, especially in terms of increased rates of treatment-related cardiovascular or renal disease. However, early treatment did not significantly increase the risk of either of these conditions, but it did signficantly lower the risk of death from any cause, a serious AIDS-related event or a serious non-AIDS--related event.
Overall, patients who started therapy earlier had lower rates of tuberculosis and cancer---including cancers not typically associated with AIDS.