HIV treatment should begin earlier: study

EPIDEMICS

New, more efficient anti-AIDS drug for untreated patients
Medical researchers on Sunday unveiled clinical trials of new anti-AIDS drug that better controls the spread of the deadly virus among previously untreated patients. Developed by US pharmaceutical giant Merck and Co, Isentress is the first of a new type of anti-AIDS medication called HIV integrase inhibitor, based on the enzyme that controls HIV virus reproduction. The study's Phase III clinical trials -- the last step before an approval request can be submitted to the Food and Drug Administration (FDA) -- showed Isentress reduced HIV viral load to undetectable levels in 86 percent of patients, against only 82 percent treated with efavirenz, an older anti-HIV medication also developed by Merck. Drug-related adverse effects were also significantly fewer in patients treated with Isentress (44 percent) than with efavirenz (77 percent), the researchers told the 48th annual Interscience Conference on Antimicrobial Agents held this weekend in Washington. Patients taking part in the clinical trial also took tenofovir and emtricitabine in combination with Isentress and efavirenz, Merck said in a statement. On October 12, 2007, the FDA granted Isentress accelerated approval for use with patients that showed initial signs of resistance to existing anti-retroviral treatment, a common problem among AIDS patients. Merck estimates that among some 500,000 US patients treated with anti-HIV cocktails, up to 40 percent have developed resistance to treatment. Industry analysts said treatment with Isentress pills twice a day could bring Merck one billion dollars in sales over the next three years, competing directly with rival Gilead Sciences' elvitegravir, also undergoing clinical trials. A separate study presented at the ICAAC conference showed anti-retroviral treatment was more effective if begun earlier: patients treated when CD4 cell count was at 500 had a 71 percent greater risk of dying than those treated when CD4 levels reached 350. According to the World Health Organization, 33 million people around the world are infected with the AIDS virus, mostly in the sub-Sahara Africa. One million HIV-infected people live in the United States. Some two million people died worlwide of AIDS in 2007.

by Staff Writers
Washington (AFP) Oct 27, 2008
Starting anti-retroviral treatment earlier sharply improves survival rates for people infected with HIV, according to a new study.

Researchers say analysis of thousands of HIV-positive patients between 1996 and 2006 found a 71-percent higher risk of death for those who delayed treatment compared with those initiating early highly active anti-retroviral therapy (HAART), the National Institutes of Health (NIH) reported Sunday.

The study, led by Mari Kitahata of the University of Washington-Seattle, looked at 8,374 patients whose CD4+ T-cells -- key "helper" cells in the body's immune system -- were between 351 and 500 cells per square millimeter in blood.

Thirty percent of subjects in the study began taking HAART right away, while 70 percent waited until their T-cell count dropped below 350, when the immune system is considered seriously compromised.

"The researchers found a 71 percent higher risk of death for patients who deferred treatment rather than initiating HAART, suggesting that therapy should begin at an earlier stage of HIV disease than currently recommended," NIH said in a statement.

The optimal timing for the introduction of HAART therapy -- a combination of at least three HIV medicines -- has been a point of contention for more than a decade, with some doctors suggesting holding off treatment as long as possible in order to spare patients the side effects of AIDS drugs.

Up to now, guidelines had recommended that HIV treatment begin when a person's T-cell count dropped below 350.

"The data are rather compelling that the risk of death appears to be higher if you wait than if you treat," Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases which sponsored part of the research.

The findings were presented Sunday at the 48th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Washington.

Lead researcher Kitahata said the findings were striking because of the "magnitude" of the difference in survival rate between the two groups, according to USA Today.

"Seventy percent is a significant and substantial increase in the risk of death," the daily quoted Kitahata as saying.

According to the World Health Organization, 33 million people around the world are infected with the AIDS virus, mostly in sub-Saharan Africa. One million HIV-infected people live in the United States.

Some two million people died worldwide of AIDS in 2007.

On Monday the world body sharply cut an earlier mortality forecast, saying the latest forecast now expects deaths to rise from 2.2 million in 2008 to a maximum of 2.4 million in 2012, before declining to 1.2 million in 2030.

An earlier WHO projection had HIV and AIDS deaths would rise to 6.5 million in 2030.

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EPIDEMICS

WHO slashes AIDS mortality projections

Geneva (AFP) Oct 27, 2008
The number of deaths arising from HIV and AIDS is expected to peak in the next five years, the World Health Organization said Monday, as it sharply cut an earlier mortality forecast.

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