One of the largest clinical trials ever conducted has proven beyond a shadow of a doubt that patients infected with HIV should begin treatment immediately after receiving the diagnosis. The benefits of early HIV treatment were so evident that federal health officials halted the trial.
Preliminary results showed that patients who had received anti-retroviral therapy (medication used in the treatment of HIV positive patients) while their immune systems had not yet been weakened had a far lower likelihood of developing AIDS. In contrast, those who only received the medication in later stages of the disease had higher chances of developing the immune deficiency or associated serious illnesses.
Federal authorities put a stop to the trial more than one year before its planned end date because preliminary findings were so compelling. HIV+ patients who received immediate attention had a 53 percent smaller likelihood of dying during the course of the trial. Additionally, they were also 53 percent less likely to develop AIDS or other serious illnesses.
Scientific literature had previously also addressed the benefits of early HIV treatment. But this trial is the largest to date and provides another reason for possible HIV+ patients to get themselves tested and begin therapy.
START (or Strategic Timing of AntiRetroviral Treatment) attempted to establish the best moment at which treatment should begin. Healthy but HIV positive participants were randomly assigned to either early HIV treatment therapy or a delay in medication until CD4 cells fell under the 200 cells/dL mark. CD4 cells are an essential component of the immune system and their drop is a clear sign of immune system compromise.
There were approximately 4,685 people included in the START trial, across 35 different countries. All participants had to have CD4 cell counts of over 500 to be eligible. Additionally, no participant had previously taken anti-HIV medication.
A multitude of factors were tracked during the course of the trial, from the development of the illness to deaths, heart disease, liver disease, kidney disease and even the development of non-AIDS events.
In total, bad outcomes occurred rarely in both groups given the overall good health that the patients had upon enrolling. In the first group (the early treatment receivers) only 41 cases as opposed to 86 patients in the second group (delayed treatment receivers).
Of the approximately 35 million people who are HIV positive worldwide, only 14 million are following an antiretroviral plan, UN AIDS statistics show. Similarly, in the US, there are approximately 1.2 million people diagnosed with HIV. Only 450,000 are being currently treated according to the CDC.
There is a multitude of factors contributing to such low percentages of patients being treated. For one, many HIV positive people aren’t accurately diagnosed. Insurance concerns are another decisive factor, as uninsured HIV positive patients failed to seek medical attention and could not afford the medication. Other patients had the misfortune of being treated by physicians unfamiliar with current CDC guidelines on HIV treatment.
So let’s address the elephant in the room: when exactly should treatment commence?
Dr. Anthony Fauci, National Institute of Allergy and Infectious Diseases director was clear on the matter: “The sooner the better.”
Since HIV is a dormant disease where symptoms aren’t immediately evident, few people consider they have to get tested. But immediate treatment not only slows disease progression, it also lowers the likelihood of transmitting the HIV virus to sexual partners.
“Now it’s clear that people should be offered treatment right away and told why it’s beneficial,” HIV prevention research director for the San Francisco Public Health Department Dr. Susan Buchbinder said.
Keep in mind that newer formulations and drugs come without the side-effects of earlier antiretroviral therapy.
These new findings are in accordance with the current federal guidelines on HIV treatment, but can now serve as the basis for WHO recommendation modifications.
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