THURSDAY, Feb. 7 (HealthDay News) -- Younger HIV-positive patients, especially those with higher viral loads, may have a higher life expectancy if combination antiretroviral therapy is started when their CD4 counts fall below 500 cells/mm3, according to a report published in the Feb. 5 issue of the Annals of Internal Medicine.
R. Scott Braithwaite, M.D., of Yale University in New Haven, Conn., and colleagues used data from the Veterans Aging Cohort Study to develop a computer simulation that assessed harms associated with earlier initiation of antiretroviral therapy (such as toxicity, side effects and resistance accumulation) versus benefits (such as decreased HIV-related mortality).
In 30-year-old patients, the researchers found that early treatment increased life expectancies regardless of viral load. In these patients, when treatment was initiated at CD4 thresholds of 500, 350 and 200 cells/mm3, it increased life expectancies by 18.2 years, 17.6 years and 17.2 years, respectively, for a viral load of 10,000 copies/mL, and 17.3, 15.9 and 14.5 years, respectively, for a viral load of 300,000 copies/mL. In 40-year-patients, the investigators found that treatment increased life expectancies if viral loads were greater than 30,000 copies/mL. In these patients, treatment initiated at CD4 thresholds of 500, 350 and 200 cells/mm3 increased life expectancies by 12.5, 12 and 11.4 years, respectively, for a viral load of 300,000 copies/mL.
"This simulation suggests that earlier initiation of combination antiretroviral therapy is often favored compared with current recommendations," the authors conclude. "Until more definitive results from clinical trials become available, this synthesis of data analysis and computer modeling may help clinicians make the complex decision of whether to start antiretroviral therapy."
Abstract
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