Early Therapy May Keep HIV Patients Healthy

HIV patients who started antiretroviral therapy early had better chances of maintaining healthy immune systems

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) They say timing is everything — and that may apply to HIV treatment. Starting antiretroviral therapy early may keep HIV patients healthy.

More HIV patients had normal white blood cell (T-cell) counts when they started antiretroviral therapy within a year of being infected with HIV than if they started later, a new study found.

Starting the therapy earlier may also keep HIV patients from developing acquired immune deficiency syndrome (AIDS), the authors of this study found.

"There is no cure for HIV, yet," said Steven Davis, MD, an infectious disease specialist at Baylor Medical Center at Irving. "The preservation of an intact immune system by early, continuous, compulsive [antiretroviral therapy] will assure HIV-infected persons remain healthy for new options in the future that may not require medications given every day."

Dr. Davis added that this study builds on momentum to make the earliest possible diagnosis of HIV to get patients started on treatment that will preserve their immune system.

HIV is a viral disease that attacks the immune system. It does this by killing the immune system’s T-cells, which protect the body from infections. Because the immune system cannot get rid of HIV, patients have it for life. HIV can lead to AIDS, but not all HIV patients end up with AIDS. This is where antiretroviral therapy comes in.

In this new study, Jason F. Okulicz, MD, of the Uniformed Services University of Health Sciences in Bethesda, MD, and colleagues found that about 8 percent of HIV patients who started antiretroviral therapy early were at risk of developing AIDS. In contrast, about 15 percent of HIV patients who started therapy more than a year after they were infected were at risk of developing AIDS.

Antiretroviral therapy can control HIV infection. HIV patients receiving the therapy take multiple medications meant to keep the virus from spreading in the body.

These researchers tied early therapy to a healthier immune system. Early-therapy patients had better immune response and overall results than those of late-therapy patients.

To see how healthy an HIV patient's immune system is, doctors check CD4+ levels. The higher the CD4+ count, the better the body can fight HIV and other diseases.

T-cells are also known as CD4+ cells. CD4+ stands for cluster of differentiation 4 glycoproteins. HIV attacks CD4+ cells. Over time, so few CD4+ cells are left in HIV patients that their bodies can no longer fight infections. When this happens, HIV can lead to AIDS.

The authors took the CD4+ counts of 1,119 HIV patients from the US Military HIV National History Study.

The authors found that CD4+ counts went back to normal in about 38 percent of the patients who started antiretroviral therapy within a year of being infected with HIV. In contrast, CD4+ counts went back to normal in about 28 percent of patients who started therapy after having HIV for more than a year.

About 80 percent of the HIV patients starting antiretroviral therapy after a year of infection had trouble getting CD4+ counts back to normal.

"In the past decade, anti-HIV therapies have improved considerably in their effectiveness and tolerability," Dr. Davis told dailyRx News. "If a patient diagnosed with HIV compulsively takes every dose, every day of a combination antiretroviral therapy, the levels of HIV virus can be suppressed. Moreover, the immune system can rebuild the CD4 cells lost to a range where infections, hospitalizations and cancers become much less common."

Dr. Okulicz and team concluded that putting off antiretroviral therapy for more than a year lowered the chances of immune system recovery among HIV patients.

The patients in this study were mostly young males. The study findings may not apply to female and older patients, Dr. Okulicz and team noted.

Dr. Davis further explained these limitations. "This study is limited in that it enrolled primarily young male military personnel in a setting where frequent routine HIV testing is performed. Unfortunately, routine HIV testing outside the military, despite recommendations, is often not performed such to allow identification within 12 months of infection," he said.

This study was published Nov. 24 in JAMA Internal Medicine.

This research was funded by the Veterans Affairs Research Center for AIDS and HIV Infection, the Virginia Center for Personalized Medicine and the National Institutes of Health, among others.

Drs. Edwina Wright, Davey M. Smith, Douglas D. Richman, Susan J. Little, and Robert A. Clark worked for and were funded by several private companies, such as Gilead Sciences, Pfizer and Biota Pharmaceuticals.

Review Date: 
November 30, 2014
Last Updated:
December 3, 2014