Prompted by clinical research into the early initiation of antiretroviral therapies for HIV performed at the GHESKIO clinic in Port-au-Prince, Haiti, the World Health Organization (WHO) has revised its treatment protocols for HIV patients.
Final results from the four-year study, led by Weill Cornell Medical College's infectious and tropical disease experts, were published in the July 15 issue of the New England Journal of Medicine.
The research indicates that rather than waiting until a patient's CD4+ T cells fall below the 200 cells per cubic millimeter threshold, as the previous WHO guidelines suggested, immediately initiating antiretroviral therapy (ART) greatly improved the efficacy of those medications. The study also linked early intervention with a decreased rate of incident tuberculosis, a leading cause of death among HIV patients in resource-poor countries.
"Beginning antiretroviral therapy before T-cell counts drop to 200 will save lives. In developed countries, HIV has, in recent years, become a manageable, chronic disease rather than the death sentence it was just a decade ago. These results further strengthen the assertion that the right therapies, initiated as soon as possible, can hold the virus at bay," says Dr. Warren Johnson, study co-author and director the Center for Global Health and the B.H. Kean Professor of Tropical Medicine at Weill Cornell Medical College.
In December 2009, seven months after the researchers concluded their data gathering, the World Health Organization and the United States Department of Health and Human Services both updated their HIV treatment recommendations to reflect the GHESKIO conclusions: that for HIV-1-infected patients, ART is best initiated at a CD4 count of 350 or lower.