Early Start Of HIV Treatment Benefits Patients' Long-Term Health

HIV is a global pandemic. In fact, this is the largest pandemic in human history. In modern time, this disease is rather unusual. This is an infection for which we have no cure, no vaccine, and against which our immune system is helpless. The virus exploits the cells of our own immune system (called CD4+ T lymphocytes) as virus-producing factories.

HIV can now be successfully controlled by drugs

Lots of drugs against HIV were developed since the emergence of infection. None of the existing drugs provide cure but they allow to control infection and prevent development of AIDS (Acquired Immunodeficiency Syndrome). HIV infected patients are considered as having AIDS if their level of CD4+ cells falls below 200 cells per microliter of blood. Healthy individuals have CD4+ count between 500 and 1200 cells per microliter.

The number of drugs against HIV is constantly growing and now we can manage the disease quite effectively. Introduction of HIV protease inhibitors in the 1990s was the turning point in the efficient HIV control. The use of modern drug combinations largely prevents the development of drug resistance. Now most people with HIV in the industrialized countries can expect to live almost as long as any uninfected person.

Best time for starting HIV therapy is still not known

HIV can take up to 10 years to get developed into AIDS. For many years after initial infection people with HIV have no health problems. Because of this long delay in the disease development, doctors were always unsure what is the best time point to start the therapeutic intervention. Anti-HIV drugs do have side effects that can lead to other health problems after many years of use. Besides, longer drug usage means higher chances of developing drug resistance. On the other hand, allowing the immune system to deteriorate too much before starting the therapy may lead to the development of HIV associated sicknesses and slower recovery once drugs have started.

As a consensus solution, medical practitioners monitoring HIV-infected patients wait for CD4+ count to drop to an intermediate level which is lower than the cell number in healthy people but still above 200 cells per microliter, the level of AIDS. In the UK, this consensus level at which drugs are started is 350 cells per microliter, in the USA – 500 cells per microliter.

Large international trial (called START - Strategic Timing of Antiretroviral Treatment) is currently on the way to find out which patients have better treatment outcomes – those who start the therapy immediately upon diagnosis, or those who wait till CD4+ level drops well below healthy norm.

Some Evidences Point To The Benefits Of Early Antiretroviral Intervention In Patients With HIV

The results of the trial are still several years away, but even without them there is a significant and growing body of scientific evidences suggesting that immediate intervention is more beneficial.

For example, in one trial half of the patients were receiving the drugs within several weeks or months after contracting the infection, and the other half was left untreated till their level CD4 went down to 350. The trial has shown that providing of relatively short (48 weeks) course of therapy within 6 months of contracting the virus allows to slow down the subsequent progression of disease significantly. Another study has demonstrated that starting antiviral combination therapy within four months of becoming infected strongly increases the likelihood of returning to the normal healthy CD4 count.

Anti-retroviral drugs now are much safer than 10 years ago. They don’t produce so many side effects in the long run and can be used for many years without significant problems. Also, many more drug combinations are now available which means that resistance problem, if arises, can be successfully tackled.

People taking anti-HIV drugs are much less likely to pass infection

Another important consideration is the fact that people undergoing antiretroviral therapy have very low blood concentration of virus (viral load). Modern drugs allow to achieve undetectable level of virus. The virus is still present in the body, but as long as the drugs are used, the virus is kept at bay on a very low level. People taking the drugs present significantly smaller danger to their sexual partners. The chances of transmitting the virus and infecting other people diminish by as much as 96%.

Swaziland: countrywide scheme of HIV prevention by early intervention

The last argument is a major driving point behind the pilot scheme that started in Swaziland this year. The scheme intends to treat with drugs all HIV-positive people in the country regardless of the stage of disease, time from initial infection, CD4+ count and viral load. Swaziland is a small African country which has the highest level of HIV in the world. Around 31% of Swaziland’s population is known to be infected. The level of HIV among pregnant women reaches as much as 43%. To stop further spread of virus, the new experimental scheme aims to reduce the viral load in the whole population of the country.

The doctors hope that Swaziland’s experiment will not only help this struggling nation but also provide a clear answer to the question of better timing for the start of therapy. It will also help to find out the best way of managing the epidemiological situation in the countries and regions badly affected by HIV.