Early use of combination-drug treatments could improve HIV survival rates

Survival rates of HIV-positive patients could be improved if combination-drug treatment were begun earlier than current clinical guidelines now recommend, according to a new study by researchers from The New York Academy of Medicine and the Johns Hopkins University Bloomberg School of Public Health.

This important study appears in the Sept. 15 issue of The Journal of Infectious Diseases.

Although highly active antiretroviral therapy, or HAART, has been available since 1996 and is proven to reduce mortality and slow HIV’s progression into AIDS, there has been longstanding debate over the optimal time to begin treatment. Current guidelines of the International AIDS Society suggest that this combination-drug therapy should begin when counts of protective CD4 cells drop below 200 per microliter of blood (200/ul). But researchers from the Academy and Johns Hopkins found that improved results were achieved among HIV-positive injection drug users (IDUs) by starting HAART when CD4 counts were above 350/ul. This indicates that treatment should be considered at earlier stages of infection, when patients are somewhat healthier.

"Our research is critically important because it shows that initiating HAART therapy in these patients when their CD4 counts are higher can save more lives and keep more of them from developing AIDS," said study co-author David Vlahov, Ph.D., Director of the Academy Center for Urban Epidemiologic Studies. Vlahov is also an adjunct professor in epidemiology at the Bloomberg School of Public Health.

Researchers followed 583 HIV-positive adults and 920 HIV-negative adults from 1997 to 2000. All 1,503 participants were active IDUs. At the start of the study, researchers measured initial CD4 cell counts, HIV status, and HAART use.

After three years, survival rates were similar among HIV-negative IDUs and HIV-positive IDUs who were on HAART therapy and had CD4 cell counts exceeding 350/ul. Both groups had better survival rates than HIV-positive IDUS who did not receive HAART and had CD4 counts exceeding 350/ul. The groups also had better survival than HAART-treated HIV-patients whose CD4 cell counts were between 200/ul and 350/ul. Currently, HAART is not routinely initiated for patients whose CD4 cell counts exceed 350/ul.