Initiating HAART Sooner Optimizes Results (web article)

For optimal results, antiviral AIDS therapy, should be started sooner than current scientific guidelines suggest, according to a new study from researchers at the Johns Hopkins Bloomberg School of Public Health and New York Academy of Medicine. Highly active antiretroviral therapy (HAART) has been available since 1996. When to begin treatment has been debated for years. More than 40 million people are living with HIV worldwide and this number continues increasing by 5 million new HIV infections each year. It is imperative that the optimal time to begin treatment is discovered.

Cunlin Wang, MD, PhD, lead author of the study and a post-doctoral fellow in the Bloomberg School of Public Health Department of Epidemiology, said, “Most studies to date which have contributed information to guide decisions on treatment initiation have compared clinical outcomes of persons who did versus did not receive therapy. We used another approach, namely to compare the treated and untreated HIV-infected persons with those who were uninfected, since a preferred ultimate goal is to have treatment make persons better as if they were uninfected”

“The major finding of the study is that survival was similar among HIV-infected injection drug users (IDUs) with CD4+ cell counts >350/µL who received HAART and HIV-seronegative IDUs,” said senior corresponding study author David Vlahov, PhD, an adjunct professor of epidemiology at the Bloomberg School of Public Health and Director of the Center for Urban Epidemiologic Studies at The New York Academy of Medicine. “Both had better survival than HIV-infected IDUs with CD4+ cell counts >350/µL who did not receive HAART, and persons with CD4+ cell counts between 200-350/µL who reported use of HAART.”

The researchers concluded that – assuming the goal of HIV treatment was to produce outcomes similar to those seen in HIV-seronegative persons – patients should initiate or switch to HAART at higher CD4+ cell counts than current clinical guidelines suggest. Current International AIDS Society guidelines suggested that patients begin HAART when their CD4 cell counts are <200/µL. Individual situations will sometimes initiate treatment when CD4 cell counts are between 200-350/µL, but not when they are greater than 350/µL.

Journal of Infectious Disease News Release (Subscription Required)

The New York Academy of Medicine News Release

“Mortality in HIV-Seropositive versus –Seronegative Persons in the Era of Highly Active Antiretroviral Therapy: Implications for When to Initiate Therapy” is published in the September 15, 2004, issue of the Journal of Infectious Diseases.

Co-authors from the Bloomberg School of Public Health Department of Epidemiology include Cunlin Wang, MD, PhD, David Vlahov, PhD, Noya Galai, Steffanie A. Strathdee, PhD, and Kenrad Nelson, MD. Joseph Bareta and Timothy R. Sterling also co-authored the study.