An Early stART to Treatment for HIV

Antiretroviral therapy should begin as early as possible for HIV patients

(RxWiki News) Antiretroviral therapy (ART) is credited with lengthening the lives of people with HIV and decreasing the number of new infections. But when should patients start the treatment?

According to a new study, the answer is the sooner, the better. Right now, it's standard practice to hold off on ART until the patient meets a set of clinical guidelines, further along in the progression of their disease. But there's a growing body of evidence to support earlier treatment. The new study found that immediate ART is preferable to deferring treatment in recently infected HIV patients.

"If you've been diagnosed with HIV, ask to start ART."

The study was led by Dr. Christine Hogan of the Medical College of Wisconsin in Milwaukee. Her research team hypothesized that administering 36 weeks worth of ART to patients who had been infected within the past six months would lower the virologic set point, or the point at which the amount of HIV in the blood levels off, after medication has been discontinued.

While other studies have investigated the issue of when to start ART, this study was the largest randomized controlled study to try and assess the outcomes from early treatment. The researchers enrolled 130 men and women over the age of 18, who had never had ART and had been infected in the past six months.

They were divided into two groups. One group got immediate treatment, and the others had their treatment deferred. The plan was to compare the virologic set point for the first group at 72 weeks, to that of the second group at 36 weeks.

But the researchers were surprised that the disease progressed so rapidly in the group that had deferred treatment, that they had to end the study early. The patients required medical treatment, and could not put off ART until the study had been completed.

For this reason, the study authors were not able to answer their question about whether the virologic set point was lowered. But they did find that the group who had immediate ART treatment had much better outcomes. Eighty-eight percent of that group had achieved complete virologic suppression by 24 weeks – meaning that their bodies were able to suppress the virus.

Early treatment also delayed the need for follow up treatment, after the patients went off therapy. Eleven percent of the immediate treatment group required additional therapy during the study period, compared to 36 percent in the deferred treatment group.

Dr. Hogan concluded that the results of the study showed that if therapy is not begun immediately, a patient may progress to meeting those clinical requirements for ART initiation faster than expected.

The study was published in The Journal of Infectious Diseases in December 2011.

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Review Date: 
December 19, 2011