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Global Trial Finds HIV Drugs Should Be Taken Right After Diagnosis
Those who started medications early fared better than those who waited until immune systems weakened
By Randy Dotinga
WEDNESDAY, May 27, 2015 (HealthDay News) -- People with HIV should start taking medications to battle the virus that causes AIDS as soon as they're diagnosed, a new international study finds.
Scientists involved in the trial were so impressed by the health benefits of early use of HIV drugs that they shut the study down early so they could offer the medications to all participants.
The findings could alter World Health Organization guidelines about the best way to treat people with HIV, experts said. Currently, WHO recommends that HIV patients not start treatment until their immune system show signs of weakening.
"We now have clear-cut proof that it is of significantly greater health benefit to an HIV-infected person to start antiretroviral therapy sooner rather than later," Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said in a statement.
"Moreover, early therapy conveys a double benefit, not only improving the health of individuals but at the same time, by lowering their viral load, reducing the risk they will transmit HIV to others. These findings have global implications for the treatment of HIV," he added.
The study started in 2011. Almost 4,700 HIV-infected men and women took part at 215 sites in 35 countries. About half were randomly assigned to begin drug treatment immediately, while the other half didn't get the medications until their immune systems weakened.
As of March, researchers found 41 cases of serious health problems -- such as death or progression to AIDS -- in those who started the treatment early, compared to 86 in those who took the medications later. Patients who took the drugs earlier also fared better no matter where they lived and regardless of the wealth of their respective countries.
While Fauci said the findings have "global implications," they'll have less impact in advanced nations where it's more common for HIV-infected people to be diagnosed early and begin to take the medications soon after that.
Even in the United States, where federal guidelines suggest that newly diagnosed patients begin taking the medications immediately, some patients without advanced disease choose not to start taking the drugs.
They do so for a variety of reasons, said Dr. Tanya Ellman, an HIV specialist and instructor in clinical medicine at Columbia University Medical Center in New York City.
Those without symptoms may worry about side effects of the medications, although the latest drugs "are much better tolerated than those from earlier years," she said. In addition, "clinicians may delay therapy if they are concerned a patient is not ready to take medications consistently," she added. "Inconsistent use will not effectively control the virus and can lead to the emergence of drug resistance," a condition in which the disease develops the ability to evade control by medication.
Ellman said the new findings support the existing federal guidelines and may lead to an expansion of WHO recommendations, which are due for an update.
Still, she said, in many places around the world, most patients aren't diagnosed until their immune systems are weakened, "making early diagnosis and more effective testing a high priority."
For more about U.S. guidelines on early HIV treatment, visit AIDSinfo.
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