Early HIV treatment reduces death, likelihood of TB, study finds

"Early treatment for HIV cuts patients' risk of death by about 75 percent," according to a study conducted in Haiti and published Thursday in the New England Journal of Medicine, Bloomberg Businessweek reports. The study also demonstrated that "early antiretroviral treatment reduces the likelihood of tuberculosis, a leading cause of death among HIV patients, by 50 percent," the news service writes (Aquino, 7/14).  

"The finding supports previous observational evidence that starting treatment while the immune system is still relatively robust can save lives," MedPage Today reports. "This is the first randomized trial comparing earlier therapy with deferred therapy," study co-author Daniel Fitzgerald of Weill Cornell Medical College in New York City said, according to the news service (Smith, 7/14).

For the randomized trial, conducted from 2005 to 2008, researchers divided 816 HIV-positive Haitian patients into two groups based on their CD4 cells counts, a measurement of immune system response, Bloomberg Businessweek continues. The early treatment group received ART when CD4 counts were greater than 200 and less than 350, and a standard treatment group, who received an identical ART regimen when their CD4 count was at or below 200.

Among the standard treatment group, "23 people died, exceeding the 6 deaths in the group whose participants were provided earlier treatment, the study showed," Bloomberg Businessweek writes (Aquino, 7/14). "There were 36 incident cases of tuberculosis in the standard-treatment group, as compared with 18 in the early-treatment group," the authors of the study also report (Severe et al., 7/15).

According to MedPage today, guidelines in the developed world "suggest a 350-cell level as the benchmark for initiating therapy in asymptomatic patients, but in developing countries, the mark has been set at 200, mainly because wider access to therapy would overburden the supply. Based at least partly on the results of this trial, Fitzgerald told MedPage Today, the World Health Organization is now recommending that treatment start at the 350-cell benchmark" (7/14).

The study authors addressed the financial considerations of expanding access to treatment based on higher CD4 cell counts in the developing world: "The median time to the initiation of antiretroviral therapy in our standard-treatment group was 2 years. At current pricing, 2 years of antiretroviral drugs will cost approximately $400 per person. Thus, for a cost of approximately $400 per person, the rate of death can be decreased by 75%, and the incidence of active tuberculosis by 50%. Furthermore, the standard-treatment group had higher rates of infectious diseases and of treatment-limiting drug reactions than did the early-treatment group and required frequent monitoring of CD4+ T-cell counts. This complex medical care consumed resources and the time of highly trained health care workers, factors that may in part offset the cost of starting antiretroviral therapy earlier" (Severe et al., 7/15).

Earlier Treatment Of HIV, Intravenous Drug Use As Major HIV Driver To Be Addressed At AIDS 2010

In an article that outlines key issues to be examined at the International AIDS Conference-AIDS 2010, including treatment and prevention, Agence France-Presse reports that "[d]octors may be advised to start prescribing anti-HIV drugs at an earlier stage of infection, a tactic that would save more lives and, say some, be a cost-saver too, as healthy people are more productive for longer." AFP continues: "This year, 25 billion dollars has to be mustered for fighting AIDS in poorer countries, according to a UNAIDS estimate. So far, there is a funding shortfall of 11.3 billion, according to an analysis published last week in the U.S. journal Science. That means a 2006 vow by U.N. members to provide 'universal access' to HIV drugs, prevention, treatment and care by the end of 2010 is set to become one more headline-making political promise that fell flat."  

"The success of ARVs (antiretrovirals) made it so people think HIV is no longer there," said AIDS 2010 co-chair Julio Montaner, president of the International AIDS Society. "Politicians basically react on a short-term agenda. Since HIV treatment became effective, people are not under the same pressure that they used to be" (7/14).

Deutsche Presse-Agentur/Earth Times also examines concerns in the HIV/AIDS community that "the global economic crisis will lead rich countries to backtrack on funds they pledged for [HIV] treatment programmes in the developing world."

In addition, the news agency reports that AIDS 2010 "coincides with a signature drive for the so-called Vienna Declaration, which blames failed drug-enforcement efforts for preventing the availability of sterile needles and calls for the decriminalization of illegal drug use." According to the news service, Eastern Europe and Central Asia "are the two regions in the world where the percentage of the population infected with HIV is clearly on the rise, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). Intravenous drug usage is the primary cause of new infections, experts say" (Yurkovsky, 7/15).

On Wednesday, former Brazilian president Fernando Henrique Cardoso together with former presidents Ernesto Zedillo of Mexico and Cesar Gaviria of Colombia endorsed the Vienna Declaration, Inter Press Service reports. The article details the drug policies of several countries, including Russia and Portugal, and subsequent shifts in rates of HIV infection (Leahy, 7/14).

The Kaiser Family Foundation will provide webcasts of select sessions from AIDS 2010 starting with the Opening Session LIVE at 19:30 CEST/17:30 GMT/1:30 p.m. ET on Sunday, July 18.