Anti-retroviral therapy became the standard treatment for HIV in the late 1980’s, not long after the discovery of the virus. Ever since they busted onto the scene, the timing of when to give a patient anti-retroviral drugs has always perplexed physicians. Certainly the drugs worked well, effectively decreased a patient’s viral load, but physicians worried about the toxic side effects while public health experts worried about the risk of viral mutation. That lead to the recommendation that the drugs only be given when a patient’s white blood cell counts drop below a certain level.
The results of a new National Institutes of Health study make those guidelines look too conservative.
Released on Wednesday, the NIH study involved over 4500 patients in 35 countries. The results show that starting antiretroviral therapy at the time of diagnosis is more effective in combating HIV. The START trial begain in 2011 andw as supposed to run for 5 years, but the study ended early when an interim review of the data showed significant differences between those who started treatment early and those who received treatment when their CD4 count fell below 350. For example, the risk of developing serious illness or death was reduced by 53% in the early treatment group.
While US treatment guidelines already recommend that all HIV+ patients take antiretrovirals independent of CD4 counts, guidelines from around the world vary. The World Health Organization guidelines recommend therapy at CD4 counts below 500. The study will hopefully lead to a change in international guidelines, increasing the rate of treatment for HIV+ individuals worldwide. That said, access to antiretrovirals is limited in many parts of the world due to their significant cost as well as the social stigma associated with HIV infection in many countries.