Study examines HIV-positive patients' death risk at CD4 counts above 350

Jul 17 2010

"Having HIV appears to be associated with a greater risk of death, even when the immune system is relatively robust and patients have not started treatment," according to a study published Friday in the Lancet, MedPage Today reports (Smith, 7/15).

Though the WHO recommends patients begin receiving antiretroviral therapy (ART) when their CD4 levels - a measure of immune system response - dip below 350, "[t]he researchers said their findings point to the need for continuing studies to examine the risks and benefits of starting antiretroviral therapy, or ART, for patients with high CD4 cell counts," HealthDay News reports.

"For this study, researchers examined data from 40,830 HIV patients, aged 20 to 59, in Europe and North America, who had at least one CD4 count greater than 350 cells per microliter while not taking ART. The patients were divided into four risk groups: men who have sex with men, heterosexuals, injection drug users, and those with other or unknown risk factors," the news service writes.

"An analysis of 401 of 419 deaths revealed that the risk of death compared to the general population was 30 percent higher for men who have sex with men, 2.94 times higher for heterosexuals, 9.37 times higher for injection drug users, and 4.57 times higher for those with other or unknown risk factors," the researchers reported, according to HealthDay News (7/15).

"The relatively low rate for men who have sex with men suggests that unmeasured confounders - such as lifestyle and socioeconomic factors - might play a role in the high rates for the other groups, the researchers said," MedPage Today continues (7/15).

However, when compared to patients with CD4 counts between 350 and 499, the death rate was 23 percent lower in patients with counts of 500-699 and 34 percent lower with patients with counts at or above 700, according to the Lancet study. "Because ART might reduce the risk of death in such patients, these findings support the need for continuing studies (such as the START trial and further exploration of existing observational databases) of the risks and benefits of starting ART at CD4 counts greater than 350 cells per μL," the authors conclude (Study Group on Death Rates at High CD4 Count in Antiretroviral Naive Patients, 7/16).

However, the study authors "cautioned that the findings may not apply outside Europe and North America, where all of the patients were under care. … They also noted that all of the patients were diagnosed early in the course of the disease, and their attitudes to healthcare might differ from those diagnosed later," MedPage Today adds (7/15).

Top Issues At AIDS 2010; Fauci On HIV Vaccine, Prevention; Funding Global HIV/AIDS Programs; HIV In The Middle East, North Africa

IRIN/PlusNews examines some of the "issues likely to top the list" during the International AIDS Conference-AIDS 2010, which kicks off July 18 in Vienna, Austria, including universal access to treatment, recent scientific developments in the area of HIV/AIDS research and the topic of treatment as prevention (7/15).

The Kaiser Family Foundation will provide webcasts of select sessions from AIDS 2010 starting with the Opening Session LIVE at 19:30 CEST/17:30 GMT/1:30 p.m. ET on Sunday, July 18.

Agence France-Presse features a conversation with Anthony Fauci, head of the National Institute for Allergy and Infectious Diseases (NIAID), who speaks of recent advances that scientists hope will bring them closer to the development of an HIV vaccine.

In the article, Fauci reflects on the results of the Thai HIV vaccine trial, which found an investigational HIV vaccine provided slight protection against HIV, and the recent discovery of three antibodies that protect against HIV. Fauci noted that while the two studies "have left scientists feeling 'much more confident that ultimately we will have a vaccine' against HIV/AIDS, ... it was still impossible to say exactly when that would be," AFP writes.

Fauci also spoke of the importance of a continued emphasis on HIV prevention programs, including such things as male circumcision and syringe exchange programs. "Ways have to be found, too, to improve access to these preventive measures, especially in developing countries where only 20 percent of 'populations who would benefit' actually have access to them, he added," the news service writes (Santini, 7/15).

In other news, Medecins Sans Frontieres (MSF) on Thursday said international donors need to maintain their commitments for global HIV/AIDS programs ahead of AIDS 2010, during which they pointed to their recent report that estimated the potential consequences of "'delayed, deferred, or denied'" global HIV/AIDS funding on patient populations worldwide, Reuters reports.

"The report suggested that far from cutting back on treatment projects in high-risk developing regions such as sub-Saharan Africa, donors should recognise that investing now in earlier treatment for more patients would pay off later," the news service writes (Kelland, 7/15).

"MSF's study showed that early and sustained treatment of HIV patients had born fruit in several regions, including Malawi's Thyolo district where the overall death rate dropped by a stunning 37 percent between 2000 and 2007, thanks to universal access to ARVs," AFP reports. "Where patients get treatment, 'there is an overall reduction of mortality in the community, there is also less tuberculosis and we start to see, where there is a high coverage of ARV, also a reduction in the number of new cases (of HIV/AIDS),' said [Mit] Philips," who authored the MSF report (7/15).

"In light of the financial crisis, donors may be tempted to walk away from their commitments to provide universal access to AIDS treatment," the report said, according to Reuters. "But these policies are short-sighted and fail to take into account long-term payoffs, including savings in economic terms, as well as increased quality of life and quality outcomes," Reuters continues.

The report also said the U.S. is "'flatlining' funding for AIDS treatment,'" the news service adds (Kelland, 7/15).

In related HIV/AIDS coverage, the National reports on the U.N. Development Program and UNAIDS' decision to form a commission to examine "whether legal structures criminalise certain types of high-risk behaviour and drive the disease underground" and what that might mean for the Middle East.

"Last month's U.N. conference in Dubai found many countries in the Middle East and North Africa fall 'well short' of providing universal treatment, with sufferers often subject to ill-treatment, social stigma and discrimination," the newspaper writes (Reinl, 7/15).

Meanwhile, the Economist looks at the travel restrictions people living with HIV/AIDS face throughout the world, including the Middle East. "In the past year, both China and America have lifted 20-odd-year bans stopping individuals with HIV from entering, but 51 countries still restrict movement in some form (be it entry to the country or a stay therein) based on a person's HIV status," the magazine writes. The magazine features a graphic demonstrating the countries that apply "the severest restrictions to HIV sufferers, including the denial of entry visas and even deportation" (7/15).