Important note: Information in this article was accurate in July 2000. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; Monday, July 3, 2000
Prepared by AIDS Weekly editors from staff and other reports
NewsRx -- When should drug therapy to treat HIV-1 infection be initiated?
This is the subject of the fourth in a series of six articles published by The Lancet1 in the build-up to the World AIDS 2000 Conference in Durban, South Africa, July 9-14.
Patients' activist Mark Harrington and clinician Charles Carpenter discuss data that justify a balanced approach and the feasibility of randomized controlled trials to provide clearer answers about when to start HIV drug treatment.
Current data show that combination antiretroviral therapy for HIV-1 infection benefits people with CD4 cell counts less than 350 cells/µL. Based on currently known risks and benefits, they believe that if CD4 cell counts and viral load are monitored carefully, and highly active antiretroviral therapy (HAART) is started commonly when the CD4 cell count drops below 350 cells/µL, then clinically relevant immune-system damage and progression to AIDS and death can be greatly delayed or prevented.
They comment that this approach is dictated by three features of HIV-1 infection that are not typical of infectious diseases: no available regimen can eradicate HIV-1; all currently effective regimens may cause undesirable (sometimes life-threatening) toxic effects; and, unless regimens are strictly adhered to, multidrug resistance can develop, limiting future treatment options.
They conclude that therapy started too early can result in cumulative side effects of the drugs used, and the development of multidrug resistance, which may outweigh the net benefits of the lengthening of life. If therapy is started too late, increases in disease progression and death outweigh the risk of adverse events.
Mark Harrington can be contacted via the Treatment Action Group (TAG), 350 Seventh Avenue, Suite 1603, New York, NY 10001, USA. Tel: +1 212 971 9022; fax: +1 212 777 8130; e-mail: <markharrington@aol.com>.
This article was prepared by AIDS Weekly editors from staff and other reports.
Reference
1. Lancet 2000 Jun 17;355(9221):2147-52.
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