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Early Antiretroviral Therapy Benefits HIV-Positive Patients

Significantly increased risk of death observed in patients who received deferred therapy

THURSDAY, April 2 (HealthDay News) -- In asymptomatic HIV-positive patients, early initiation of antiretroviral therapy significantly improves survival compared to deferred initiation, according to a report published online April 1 in the New England Journal of Medicine.

Mari M. Kitahata, M.D., and colleagues from the North American AIDS Cohort Collaboration on Research and Design of the International Epidemiological Databases to Evaluate AIDS project conducted two parallel analyses. The first analysis involved 8,362 patients, 2,084 (25 percent) of whom started therapy at a CD4+ count of 351 to 500 cells per cubic millimeter. The second analysis involved 9,155 patients, 2,220 (24 percent) of whom started therapy at a CD4+ count of more than 500 cells per cubic millimeter. The deferred-therapy groups started therapy when their counts fell below these thresholds.

In the first analysis, the researchers found that deferred therapy was associated with a 69 percent increased risk of death. In the second analysis, they found that deferred therapy was associated with a 94 percent increased risk of death.

"In 1996, antiretroviral therapy was recommended for all HIV-infected patients with a CD4+ count of less than 500 cells per cubic millimeter, but concern about resistance, inadequate adherence, and toxic effects led to a shift to delay initiation of treatment until later stages of HIV disease," the authors write. "Significant advances in our understanding of the role of HIV infection in inflammation and immune activation resulting in potentially irreversible immune-system and end-organ damage have renewed the impetus for earlier treatment of HIV."

Several of the study authors have disclosed financial relationships with various pharmaceutical companies.

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