The new guideline comes from the International Antiviral Society-USA panel, and revises current recommendations, which advise that drug treatment should begin when levels of patients’ immune cells, known as the CD4 count, drop below 350 cells per mm3 of blood. The new guidelines initiate treatment immediately, regardless of a patient’s CD4 count.
The panel says that it revised its advice for ARV treatment based on studies conducted over the past two years, which show that patients at all stages of infection may benefit from drug treatment. In particular, trials in which HIV-positive patients began ARVs soon after infection showed that they could lower their risk of tuberculosis, bacterial infections, other AIDS-related complications and even death from the disease by 41%, compared with those who waited to start therapy later, when their CD4 counts dropped to 350. In another study, those who began drug treatment at CD4 counts of 350 had a 38% increased risk of developing full blown AIDS and dying prematurely of the disease than those who didn’t wait as long to start ARVs.
The question of when to initiate ARV has always been a tricky one for AIDS clinicians; because the drugs have serious side effects, doctors must balance their potential life-saving benefit against these adverse events, including cancer and lipid imbalances. But with advancements in drug development, newer therapies that are easier to take have made it possible to start patients earlier, and when it comes to confronting HIV, experts say, the sooner the better.
The guidelines include recommendations for which drug combination newly infected patients should receive. The combinations include a cocktail of four medications that all hit HIV at different points in its life cycle: two nucleoside reverse transcriptase inhibitors, a non nucleoside reverse transcriptase inhibitor, along with either a ritonavir-based protease inhibitor or an integrase inhibitor.
Starting drug treatment for all HIV-positive patients may also have another benefit — recent trials have hinted that hitting the virus hard with anti-HIV medications soon after a person is infected may hamper HIV’s ability to jump from that patient to a new host during sexual contact. If that’s the case, then the new guidelines may also help to reduce transmission of the disease. “There is no CD4 cell count threshold at which starting therapy is contraindicated,” the authors write.
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