Starting HIV-Positive Patients on HAART Early Reduces Treatment-Related Complications, Study Finds
HIV-positive patients who begin highly active antiretroviral therapy when they have high CD4+ T cell counts reduce their risk for treatment-related side-effects, according to a study presented on Tuesday at the 13th Conference on Retroviruses and Opportunistic Infections in Denver, Reuters reports. Kenneth Lichtenstein of the University of Colorado Health Sciences Center and CDC and colleagues looked at the medical records of 2,304 HIV-positive patients on HAART in eight U.S. cities between 1996 and 2005. Researchers analyzed the records for three types of treatment-related complications: kidney failure; peripheral neuropathy, a type of nerve damage; and lipoatrophy, a wasting condition. HIV-positive people often are told to begin taking HAART when their CD4+ T cell counts are below 200, but some people in the study began the treatment with CD4+ T cell counts of 350, 500 or higher, according to Reuters. The study found that patients who began treatment with a CD4+ T cell count higher than 350 were 60% less likely to develop kidney failure, 30% less likely to develop peripheral neuropathy and 60% less likely to develop lipoatrophy, compared with patients who had a CD4+ T cell count of less than 200 (Fox, Reuters, 2/7). "The intuitive thing to think is ... the longer you're on the drug, the greater the toxicity," Lichtenstein said, adding, "The surprise in our study is if you didn't develop toxicity in the first six months to a year, your risk of toxicity went down, rather than up" (Stobbe, AP/Macon Telegraph, 2/7). He said the study also found that inflammation appeared to be an important factor. "The state of inflammation associated with the disease brings up the toxicity," Lichtenstein said, adding that this suggests that delaying HAART is not necessary (Reuters, 2/7). According to the AP/Telegraph, the study, which has not yet been published, does not distinguish between the effects of certain drugs. John Brooks, a researcher with CDC who worked on the study, said the findings suggest patients should consider early treatment, but he added, "I don't think anyone is ready to recommend changing the guidelines based on a single report" (AP/Macon Telegraph, 2/7).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.