AIDS Patients Require Drugs Sooner Than Previously Advised
Drug therapy for patients with the AIDS virus should begin even sooner than current guidelines advise, according to new findings reported on Monday.
"The data are rather compelling that the risk of death appears to be higher if you wait than if you treat," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which helped support the study.
Delaying treatment could actually double a patient’s rick of death in the next few years compared to patients whose treatment started earlier.
Previously, doctors had assumed that it was best to keep patients off of AIDS drugs as long as possible to protect against their side effects.
HIV has become a manageable chronic condition thanks to new powerful drug combinations, however these drugs can cause heart and cholesterol problems, diarrhea, nausea and other side effects. They also must be taken faithfully or resistance develops and the drugs stop working.
That is why guidelines by the government and the International AIDS Society recommend that patients who are not yet having AIDS symptoms delay starting on the drugs until their T-cell counts fall below 350 per cubic millimeter of blood (healthy people have more than 800).
About 56,300 Americans are newly infected with HIV each year. The virus ravages T-cells – "helper cells" of the immune system that fight off germs. Once that happens, people can fall prey to a host of diseases that prove fatal.
Fauci and other AIDS experts expect the study will prompt change among doctors, which would cause several hundred thousand Americans who are not taking AIDS drugs to start now.
"There was this thinking, maybe the drugs were worse than the disease. If you could wait as long as you possibly could wait, you would have fewer side effects," said Dr. Robert Schooley, infectious diseases chief at the University of California, San Diego.
However, Dr. Mari Kitahata of the University of Washington in Seattle and researchers studied data on 8,374 people in the United States and Canada with T-cell counts of 351 to 500 from 1996 to 2006.
About 30 percent started taking AIDS drugs right away; the rest waited until their T-cell counts fell below 350, as guidelines recommend.
“We found a 70 percent improvement in survival for patients who initiated therapy between 350 and 500" compared to those who waited, Kitahata said.
Two other recent studies found that people who start taking AIDS drugs while their T-cell count is above 350 have a better chance of getting their count back to normal than those who start later. Another key study found that briefly interrupting treatment to give patients "drug holidays" puts them at grave risk.
"These studies have all shown the same thing – that we were starting too late" and need to keep treatment going once it starts, said Schooley. He helped write the AIDS society guidelines and consults for several companies that make AIDS drugs.
The bigger problem is that as many as a third of people diagnosed with HIV only discover they are infected after their T-cell counts already have fallen below 350 and they have serious complications.
"People are still being tested and identified way too late," and the new study shows how important it is to test and find people sooner, said Dr. Daniel Kuritzkes, an AIDS specialist at Brigham and Women’s Hospital in Boston.
The new study’s findings do not apply to HIV patients who also have hepatitis, kidney damage or other medical problems, or who are pregnant – doctors have long advised that these people start treatment as soon as they are diagnosed.
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