Posts Tagged ‘ART’
San Francisco public health doctors are urging patients to begin taking HIV medications soon after their diagnosis rather than waiting until their immune systems become compromised. Reports of this major policy change first surfaced last week in a New York Times article.
These new city guidelines – to be announced next week by the Department of Public Health – may be the most forceful in the world in their strong endorsement of early treatment against HIV. Doctors will offer patients combination therapy and advise them to pursue early treatment, but the patients will ultimately decide whether to begin therapy right after their diagnosis.
Antiretroviral therapy is traditionally used to stall or prevent the progression of HIV to AIDS, and it can also prevent other side effects of a degenerating immune system, like opportunistic infections and cancers. The downside is that ART can also cause liver and kidney damage among other complications.
The issue of when to begin treatment is an often discussed decision that we are asked to make with very little information on when to begin a lifetime regimen of costly and sometimes toxic medications. The answer to when remains in dispute, but San Francisco doctors are opting for treatment before permanent damage is done
Even our nation’s experts are solidly divided on the issue of when to begin treatment. In December of last year, only half of the HIV experts on the 38 member Department of Health and Human Services panel favored starting drugs in patients with healthy levels of more than 500 T-cells.
The issue for doctors and patients is whether the damage caused by HIV is more life threatening than the damage caused by some of the antiretroviral drugs. Doctors just don’t know the answer to that question right now. You can expect a great deal of discussion on that in the coming weeks and months.
We will be exploring treatment options in the next few days on our blog. Please check back for new insights on when to start treatment.
Many patients diagnosed with HIV today will have normal life expectancies, two European studies have found.
The studies were presented at the 17th Conference on Retroviruses and Opportunistic Infections (CROI) found that certain groups of patients including those diagnosed recently and some patients with high CD4 counts when they begin treatment – will have normal or near to normal life expectancies.
In the first study done in the Netherlands, for a patient diagnosed at the age of 25 their life expectancy came to 52.7 years. This means they would die, on average, at the age of 77.7. There was relatively no difference to the life expectancy for 25 year olds in the overall Dutch population which was 53.1 years.
The study known as ATHENA is a long-term national observational study that has been following HIV positive people in the Netherlands since the introduction of combination Anti-Retroviral Therapy (ART)
The researchers noted, “The life expectancy of asymptomatic HIV-infected patients who are still treatment-naive and have not experienced [an HIV or AIDS-defining symptom] at 24 weeks after diagnosis approaches that of age and gender-matched uninfected individuals.”
It is important to note that the follow-up time in the study was short and that the predictions are dependent on ART treatment continuing to work. It is worth emphasizing that this study also excluded late-diagnosed patients.
In the second study performed in France in 2005, a similar result was reported.
In a time when we are concerned about the cost and support for continuing ART treatment, these studies reinforce the importance of early diagnosis and continued therapy.
To read more about these studies and how they were conducted, please read: