HIV/AIDS- early treatment may improve chances of survival
May 10, 2009
PEOPLE found with HIV/AIDS should start taking drugs for the AIDS virus earlier than currently recommended if they are to stand a good chance of survival, researchers have said. <br>
By Halima Shaban
PEOPLE found with HIV/AIDS should start taking drugs for the AIDS virus earlier than currently recommended if they are to stand a good chance of survival, researchers have said.
An analysis of more than 45,000 people with HIV in Europe and North America found people were 28% more likely to develop full-blown AIDS or die if they deferred antiretroviral therapy (ART) until the point currently recommended in many countries.
There is no cure for the human immunodeficiency virus (HIV) that causes AIDS, but combinations of drugs can keep the virus from replicating and damaging the immune system.
Doctors hardly recommend commencement of treatment until there is evidence of damage to the system, measured by counting the number of immune cells called CD4 T-cells.
Current guidelines call for treatment only after the CD4 count falls below 350 cells per millilitre of blood. A normal CD4 count is between 500 to 1,500 T-cells per cubic millimetre of blood.
T-cells are a type of specialised protein that help protect the body and are the target of HIV which also uses them to multiply. In doing so, HIV weakens the immune system, making it unable to protect the body from infection.
The CD4 count, therefore, indicates how strong your immune system is, the stage of your HIV infection, guides treatment and predicts how your disease may progress.
Jonathan Sterne from Britain’s University of Bristol, in a research carried out in Britain, however, found that waiting until the CD4 had fallen to 251 to 350 cells/mm was associated with a significantly worse outcome than starting therapy in the range of 351 to 450 cells/mm3.
But Dr. Zainab Akol, the AIDS control programme manager at the Ministry of Health, says if treatment is started too early, resources could be wasted and the risks of unnecessary toxic effects and drug resistance increased.
“Because of known toxicities, resistance and unknown long-term effects, many doctors see no benefit in beginning treatment in patients until their CD4 count drops to a level between 350 cells/mm3 and 200 cells/mm3,†says Akol.
She says one does not start on antiretroviral treatment the moment they test positive. One only starts when the CD4 cell count is at 350 or below.
“It is recommended that ART be started only in those who are symptomatic and have evidence of significant immune system damage,†Akol says.
She adds that if ART is started early, these patients will feel no difference, but if someone is started on treatment at the current recommended stage, these people improve greatly and appreciate the treatment, reducing chances of people absconding from treatment.
On the other hand, one must not start too late. The immune system recovers better if HIV is suppressed and if the CD4 cell count has not dropped too low.
Treatment started too late may not yield good results because the immune system may take longer to recover.
Dr. Akol says antiretroviral drugs are not taken for a short time and patients must also display a willingness to adhere to treatment.
“If patients don’t take their treatment properly, it will probably fail and the virus will become resistant to the drugs,†she says
Eddy Byamukama, a person living with HIV/AIDS, says he started ART treatment when his CD4 count was at 150. It has increased to 600 and he attributes this to drug adherence.
The policy on ART states that if a person is HIV-positive and has a CD4 count of 250 and below or is in stage III and 1V and is above 15 years, he should be started on ART.
Stage III is when a person has had HIV/AIDS for five years and they are symptomatic while stage IV is an advanced stage characterised by tuberculosis, cancer or meningitis.
In children, however, the earlier ART is administered, the better for the infected child. Dr. Victor Musiime, the head of paediatrics at the Joint Clinical Research Centre, says they are currently giving immediate ART to young babies.
“All children below one year confirmed to be HIV-positive are started on ART because their immune system is not well developed,†Musiime says, adding that HIV attacks the developing immune system of infected infants quickly.
Musiime says a study on Children with HIV Early Antiretroviral Therapy (CHER) has shown that administering ART to infants immediately after diagnosis, rather than waiting for their CD4 count to drop or other symptoms to prompt treatment, reduced their chance of dying by 76%.
The study found that giving ART to HIV-infected infants beginning at an average of seven weeks made them four times less likely to die in the next 48 weeks, compared with postponing ART until signs of illness or a weakened immune system appeared.
The CHER study was carried out in South Africa to evaluate different approaches for treating HIV-infected infants under three months and to determine the optimal time to begin antiretroviral therapy.
Dr. Akol, however, says for pregnant women and breastfeeding mothers, ART should be started when their CD4 count is 350 and below.
Debate on when exactly to start ART still rages on. Medical specialists disagree over when to start the treatment but research is still ongoing, and perhaps, a consensus will be reached.
PEOPLE found with HIV/AIDS should start taking drugs for the AIDS virus earlier than currently recommended if they are to stand a good chance of survival, researchers have said.
An analysis of more than 45,000 people with HIV in Europe and North America found people were 28% more likely to develop full-blown AIDS or die if they deferred antiretroviral therapy (ART) until the point currently recommended in many countries.
There is no cure for the human immunodeficiency virus (HIV) that causes AIDS, but combinations of drugs can keep the virus from replicating and damaging the immune system.
Doctors hardly recommend commencement of treatment until there is evidence of damage to the system, measured by counting the number of immune cells called CD4 T-cells.
Current guidelines call for treatment only after the CD4 count falls below 350 cells per millilitre of blood. A normal CD4 count is between 500 to 1,500 T-cells per cubic millimetre of blood.
T-cells are a type of specialised protein that help protect the body and are the target of HIV which also uses them to multiply. In doing so, HIV weakens the immune system, making it unable to protect the body from infection.
The CD4 count, therefore, indicates how strong your immune system is, the stage of your HIV infection, guides treatment and predicts how your disease may progress.
Jonathan Sterne from Britain’s University of Bristol, in a research carried out in Britain, however, found that waiting until the CD4 had fallen to 251 to 350 cells/mm was associated with a significantly worse outcome than starting therapy in the range of 351 to 450 cells/mm3.
But Dr. Zainab Akol, the AIDS control programme manager at the Ministry of Health, says if treatment is started too early, resources could be wasted and the risks of unnecessary toxic effects and drug resistance increased.
“Because of known toxicities, resistance and unknown long-term effects, many doctors see no benefit in beginning treatment in patients until their CD4 count drops to a level between 350 cells/mm3 and 200 cells/mm3,†says Akol.
She says one does not start on antiretroviral treatment the moment they test positive. One only starts when the CD4 cell count is at 350 or below.
“It is recommended that ART be started only in those who are symptomatic and have evidence of significant immune system damage,†Akol says.
She adds that if ART is started early, these patients will feel no difference, but if someone is started on treatment at the current recommended stage, these people improve greatly and appreciate the treatment, reducing chances of people absconding from treatment.
On the other hand, one must not start too late. The immune system recovers better if HIV is suppressed and if the CD4 cell count has not dropped too low.
Treatment started too late may not yield good results because the immune system may take longer to recover.
Dr. Akol says antiretroviral drugs are not taken for a short time and patients must also display a willingness to adhere to treatment.
“If patients don’t take their treatment properly, it will probably fail and the virus will become resistant to the drugs,†she says
Eddy Byamukama, a person living with HIV/AIDS, says he started ART treatment when his CD4 count was at 150. It has increased to 600 and he attributes this to drug adherence.
The policy on ART states that if a person is HIV-positive and has a CD4 count of 250 and below or is in stage III and 1V and is above 15 years, he should be started on ART.
Stage III is when a person has had HIV/AIDS for five years and they are symptomatic while stage IV is an advanced stage characterised by tuberculosis, cancer or meningitis.
In children, however, the earlier ART is administered, the better for the infected child. Dr. Victor Musiime, the head of paediatrics at the Joint Clinical Research Centre, says they are currently giving immediate ART to young babies.
“All children below one year confirmed to be HIV-positive are started on ART because their immune system is not well developed,†Musiime says, adding that HIV attacks the developing immune system of infected infants quickly.
Musiime says a study on Children with HIV Early Antiretroviral Therapy (CHER) has shown that administering ART to infants immediately after diagnosis, rather than waiting for their CD4 count to drop or other symptoms to prompt treatment, reduced their chance of dying by 76%.
The study found that giving ART to HIV-infected infants beginning at an average of seven weeks made them four times less likely to die in the next 48 weeks, compared with postponing ART until signs of illness or a weakened immune system appeared.
The CHER study was carried out in South Africa to evaluate different approaches for treating HIV-infected infants under three months and to determine the optimal time to begin antiretroviral therapy.
Dr. Akol, however, says for pregnant women and breastfeeding mothers, ART should be started when their CD4 count is 350 and below.
Debate on when exactly to start ART still rages on. Medical specialists disagree over when to start the treatment but research is still ongoing, and perhaps, a consensus will be reached.