Early treatment is better for treating HIV than waiting, a new study confirms.
People who started taking AIDS drugs soon after they were diagnosed were healthier and had fewer side-effects than people who waited, the study found. Researchers were so impressed by the results that they have stopped the study early and will offer the drugs to all the volunteers taking part.
“It’s just more scientific evidence to back what we’ve been saying for a time now,” said Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, which paid for the bulk of the study.
U.S. and World Health Organization guidelines already call for early treatment of the human immunodeficiency virus (HIV) that causes AIDS. The drugs cannot cure patients but they keep the virus suppressed so that it doesn’t damage the body and so that patients are much less likely to infect someone else.
“I actually had no doubt how it was going to turn out."
But there have been some concerns. Some people worry that the drugs can cause side-effects, and others worry that patients might not always take the drugs regularly, which can give the virus an opportunity to mutate into drug-resistant forms.
This study shows that the side-effects are not a major threat to people’s health, although it did not last long enough to answer whether people might develop resistant virus. Other studies have shown this doesn't happen often when patients are educated and supervised, however.
“We now have clear-cut proof that it is of significantly greater health benefit to an HIV-infected person to start antiretroviral therapy sooner rather than later,” Fauci said.
“These findings have global implications for the treatment of HIV.”
The Strategic Timing of AntiRetroviral Treatment (START) study involves 4,685 HIV-infected men and women in 35 countries who had HIV but who had never been treated for it.
The virus attacks immune system cells called CD4 T-cells, and one way to measure infection is to test for these cells. The lower a patient’s CD4 T-cell count, the more likely he or she is to progress to AIDS. Acquired immune deficiency syndrome or AIDS can lead to a range of diseases, from various cancers to pneumonia, diarrhea and death.
Half the patients in the study started taking HIV cocktails when they still had a healthy CD4 count of 500 or above. Half waited until their count was about 350 to 400 CD4 cells per cubic millimeter of blood.
They were watched for three years to see who developed AIDS related cancers or infections, as well as non-AIDS related conditions such as heart disease or kidney disease.
Those who waited to start taking the drugs were 53 percent more likely to have one of these “events,” Fauci and colleagues told reporters.
The findings held across all the countries and were the same among people with high income or low income. The study was supposed to last until 2016, and the volunteers taking part will continue to be offered the drugs and will be monitored for at least that long.
“I actually had no doubt how it was going to turn out. I just think we needed to prove it in a very well controlled way,” Fauci told a telephone briefing.
“This is an important milestone in HIV research,” said Dr. Jens Lundgren of the University of Copenhagen, who helped sponsor the trial.
“We now have strong evidence that early treatment is beneficial to the HIV-positive person. These results support treating everyone irrespective of CD4 T-cell count.”
“It is good for the HIV-infected individual, for their health and well-being, and it’s also good for prevention.”
Jim Neaton, a professor of biostatistics at the University of Minnesota, said the results should convince anyone who doubts the benefits of treating someone as soon as he or she is diagnosed with HIV.
“The definitive findings from a randomized trial like START are likely to influence how care is delivered to millions of HIV-positive individuals around the world,” Neaton said.
Mitchell Warren of the HIV advocacy group AVAC said he was reassured. “Guidelines were being developed based on what we thought. And now we can say we know,” he told NBC News.
“It is good for the HIV-infected individual, for their health and well-being, and it’s also good for prevention.”
That doesn’t mean it will be easy to pay for the treatment, Fauci noted. “It’s another motivating force to get the resources,” he said. “It’s going to cost money because treatment costs money.” But, he noted, people who got early treatment didn’t develop expensive conditions, and inexpensive, generic versions of HIV drugs are widely available.
“There is no doubt that it going to be less expensive to treat people early,” he said.
HIV infects 35 million people worldwide. In the United States, more than 1.2 million people have HIV, and about 50,000 people are newly infected each year. Medications can keep infected people healthy, but there is no cure.
Scientists have invented two dozen different drugs that can slow down the virus.
