HIV-Positive People Might Benefit From Early Treatment, Study Presented at CROI Indicates
HIV-positive people who begin drug regimens soon after infection might have better treatment outcomes than those who delay taking medication, according to a study presented Monday at the 16th Conference on Retroviruses and Opportunistic Infections in Montreal, Canada, Bloomberg reports. Radjin Steingrover of the Academic Medical Center in Amsterdam presented the study. Peter Leone -- HIV/AIDS researcher at the University of North Carolina and medical director of the North Carolina Department of Health's HIV department -- said that the study is the first to demonstrate that immediate treatment might benefit people living with HIV.
During the first few weeks after contracting HIV, often called the "acute phase," HIV grows rapidly in the body. To determine the benefits of treating people during the acute phase, the researchers provided early treatment for six to 15 months to 55 HIV-positive people and did not provide early treatment to another group of 47 people. The researchers found that the 55 HIV-positive people who received treatment soon after infection generally progressed to taking long-term treatment after an average of 45 months. The 47 patients who did not receive early treatment generally progressed to long-term treatment after 32 months. According to Steingrover, the study suggests that immediate HIV treatment can delay the need for long-term drugs by about one year.
"To the question of whether this is beneficial [to the patient], I think the answer is yes," Steingrover said. "Until now, the benefits to the patient have just been theoretical," Leone said. According to Bloomberg, previous recommendations and findings for when to begin treatment range from CD4+ T cell levels of 350 copies per milliliter of blood to 500. According to Bloomberg, health workers often encounter difficulty in detecting HIV at the earliest stages because the immune proteins responding to the virus do not typically appear until a few weeks after infection. Therefore, tests to diagnose the virus during the acute phase could help people begin treatment earlier and improve treatment outcomes. According to Leone, the study "suggests that there's an opportunity to do more, if we have more research on what's going on in this early period of infection."
According to Bloomberg, additional studies presented at the conference indicate that HIV-positive people who begin long-term treatment earlier have better treatment outcomes. One study, presented by University of Washington HIV/AIDS researcher Mari Kitahata, found that the mortality risk among HIV patients who delayed long-term treatment was 60% higher than the risk among patients who began long-term treatment before their T cell counts decreased to 500. Another study -- led by Jonathan Sterne of the research group When to Start Consortium and colleagues from the University of Bristol -- examined treatment outcomes for patients with a variety of T cell levels. The study found that patients who began long-term treatment earlier had better survival rates and treatment outcomes than those who delayed treatment (Lauerman, Bloomberg, 2/9).
Interleukin-2 Does Not Improve Treatment Outcomes Among HIV-Positive People, Studies Say
In related news, two studies presented at the conference found that the immune cell drug interleukin-2 does not improve treatment outcomes among HIV-positive people, Bloomberg reports. Interleukin-2 is a cytokine, which is a natural body chemical that spurs the creation of immune cells to replace those destroyed by disease. Although earlier trials of the drug showed promise, the two studies presented at the conference found no benefit from the treatment, the researchers said.
Marcelo Losso, HIV/AIDS researcher from the Hospital Jose Maria Ramos Mejia in Argentina, presented the first study, which examines the effect of interleukin-2 among 4,011 HIV-positive people with T cell counts greater than 300. The second study involved 1,695 HIV-positive people with T cell counts between 50 and 299. All participants were taking antiretroviral combination treatments. Both studies found that interleukin-2 raised the number of immune cells; however, the studies also found that morbidity and mortality rates were the same among both the treated and untreated groups. In addition, the first study found that serious side effects were more common among people who received interleukin-2, Losso said.
John Bartlett, HIV/AIDS researcher at Johns Hopkins University who was not involved in the studies, said the findings demonstrate that researchers "could increase CD4 levels with the treatment but not improve the outcome." He added, "Maybe getting them to the highest level possible isn't as important as we thought it was." According to Bartlett, trials of interleukin-2 have "never been able to cross the goal line" and demonstrate clinical benefits from taking the drug (Lauerman, Bloomberg, 2/10).