New study adds further guidance about when to start antiretroviral therapy for HIV
| September 26, 2011 | |
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One of the key decisions faced by people living with HIV — and by their health care providers — is when to start treatment. Some recent studies have found that starting highly active antiretroviral therapy (HAART) earlier is better. Now a new study led by researchers at the University of North Carolina at Chapel Hill finds there may be a limit to how early HAART should begin.
Dr. Michele Jonsson-Funk
The new results could help determine where the starting line for antiretroviral therapy should be drawn, said Michele Jonsson-Funk, PhD, research assistant professor of epidemiology at UNC Gillings School of Global Public Health and lead author of the study, published Sept. 26 in Archives of Internal Medicine. “The drugs used to treat HIV are expensive, treatment is lifelong and side effects can be serious,” Jonsson-Funk said. “So we really need to know if the patient’s investment will pay off, how large the benefit is likely to be and how long it will take to realize it.”
The “bottom line” from these findings, she says, “taken together with other studies published over the last few years, is that initiating therapy when the patient’s CD4 count is between 350 and 500 appears to be beneficial over the long term. For patients with a CD4 count above 500, the jury is still out.”
The CD4 count measures how many CD4 cells — a type of white blood cell that fights infection — are in one cubic milliliter of blood. In patients infected with HIV, the virus that causes AIDS, a lower CD4 count usually is associated with more advanced disease, while a higher CD4 count is viewed as a sign of better health.
There is wide agreement among researchers and health care providers that HIV patients with CD4 counts below 350 should be on antiretroviral therapy, Jonsson-Funk said. However, there is still uncertainty regarding how much patients benefit, if at all, from starting treatment at higher CD4 counts. This study was aimed at answering that question.
Study results are based on statistical analyses performed by Jonsson-Funk and study co-authors of data collected from 9,455 HIV patients in Europe, Australia and Canada who were enrolled in the CASCADE (Concerted Action on SeroConversion to AIDS and Death in Europe) Collaboration between 1996 and 2009.
In addition to Jonsson-Funk, UNC public health school co-authors of the study are Stephen R. Cole, PhD, professor; James C. Thomas, PhD, associate professor; and Alice D. White, PhD, adjunct faculty member, all in the epidemiology department.
Also from UNC is co-author Joseph J. Eron Jr, MD, professor in the School of Medicine’s Division of Infectious Diseases and member of the UNC Center for AIDS Research. Eron also co-authored a landmark, UNC-led HIV prevention study called HPTN052, which found that early treatment of HIV-infected people (when CD4 counts were between 350 and 550) with combination antiretroviral therapy led to a 96 percent reduction in transmission of the virus to their uninfected partners and a 40 percent reduction in their own risk of developing a serious illness. These results consistent with those reported by Jonsson-Funk.
Study co-authors from other institutions are Jennifer S. Fusco (GSK), Kholoud Porter, PhD (University College London); Jay S. Kaufman, PhD (McGill University); Marie Davidian, PhD (N.C. State University), and Katherine E. Hartmann, MD, PhD (Vanderbilt University).
UNC Gillings School of Global Public Health contact: Ramona DuBose, director of communications, (919) 966-7467 or ramona_dubose@unc.edu. |
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