Source: DGNews  |  Posted 1 year ago

By Ed Susman

VIENNA -- July 26, 2010 -- Patients with HIV who are treated earlier in the disease course reduce the risk of death by nearly 70% -- and such treatment can be accomplished even in resource-poor settings, researchers said here at the 18th International AIDS Conference.

In the study, conducted in the South African nation of Lesotho -- which has one of the world's highest HIV infection rates -- doctors, nurses, and other healthcare providers were able to handle the scale-up of treating patients with CD4-positive cell counts <350 cells/mm³.

The current standard in Lesotho and other poor nations has been to withhold treatment until CD4-positive cells fell to <200 cells/mm³.

That policy appears to be significantly inferior to treating these patients while their CD4-positive cell counts are higher, said Nathan Ford, MD, Access to Essential Medicines Campaign of Médecins Sans Frontières, Cape Town, South Africa, in an oral presentation on July 22.

The initiation of therapy when a person's CD4-positive cell counts dropped to <350 cells/mm³ reduced mortality by 68% when compared with beginning therapy when CD4-positive cell counts dropped to <200 cells/mm³.

Dr. Ford and colleagues enrolled 538 patients in the treatment arm that started therapy below the 200-cell count level and enrolled another 639 patients who were treated when CD4-positive cells counts were >200 cells/mm³ but <350 cells/mm³.

In addition to reducing mortality by treating patients early with combination therapy, Dr. Ford said that incident morbidity was reduced 27% and hospitalisation was reduced 63%. Dr. Ford said that all the results were adjusted for age, sex, tuberculosis at initiation of treatment, and pregnancy.

"Earlier initiation is feasible in a high-prevalence, resource-limited setting," he said. "The health system was not overwhelmed." He said that some donor countries had suggested that by starting therapy earlier, many more eligible people would present for treatment and strain the healthcare facilities. That did not occur in Lesotho, Dr. Ford said.

The mean CD4-positive cell count for those treated late in disease was 111 cells/mm³, while the mean cell count for those beginning therapy earlier was 280 cells/mm³. About 60% of the patients in the late-treatment group were women; about 73.6% of the patients in the earlier-treatment group were women. About 8% of the women in the late-treatment group were pregnant and about 11% of the early-treatment group were pregnant.

About 24% of the patients in the late treatment group were co-infected with tuberculosis at the start of therapy compared with 10.3% of the patients who were initiated on therapy later.

[Presentation title: Early Initiation of Antiretroviral Therapy and Associated Reduction in Mortality, Loss-to Follow-Up and Hospitalization in a Routine Programme in Lesotho. Abstract THLBB107]