HIV Digest	HIV Digest Archive

Patients who began highly active antiretroviral therapy earlier suffered less treatment-related toxicity than patients who started HAART later, according to research presented Tuesday at the 13th Conference on Retroviruses and Opportunistic Infections in Denver. The study, carried out by CDC and the University of Colorado Health Sciences Center, is based on the medical records of 2,304 HIV patients involved in a larger 1996-2005 study.

"Earlier was better in almost everything we looked at," said Dr. Kenneth Lichtenstein of the University of Colorado. "If you stayed on treatment and started earlier, you had the best outcomes." Current guidelines that recommend delaying therapy are based on assumptions that earlier treatment worsened toxicities, but Lichtenstein and colleagues found that assumption did not pan out.

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Patients are generally told to begin HAART when their CD4 cell count is 200 or below. But some study participants began HAART at cell counts of 350, 500 and higher.

In their analysis, researchers divided patients by CD4 count at initiation of HAART and compared patients' experience of three common treatment side effects. Patients who began HAART with CD4 counts above 350 were at least 60 percent less likely to develop kidney insufficiency, 30 percent less likely to report peripheral neuropathy, and 60 percent less likely to develop lipoatrophy than patients who began HAART when their CD4 counts were 200 or below.

Inflammation appears to be an important factor, said Lichtenstein. "The state of inflammation associated with disease brings up the toxicity." Treatment was most active when there were fewer CD4 cells, he added.

In the past, HIV/AIDS patients often took many more pills, had fewer treatment options, and treatment side effects were more severe. Patients were wise to hesitate in starting therapy because, if the virus developed resistance, there were fewer effective drugs to turn to.

Drug companies have simplified regimens so that some patients can take as few as two pills a day. "Now there are four classes of drugs, soon to be five classes," said Lichtenstein. There is no reason to delay HAART, and no reason to delay testing for HIV, he said.

Editor's Note: from Reuters