Early temporary treatment for HIV can delay the time to long-term treatment

A study in this week's PLoS Medicine suggests that when people are first infected with HIV (primary HIV infection), temporary treatment with antiretroviral drugs (cART) for 24 weeks can delay the need to restart treatment during chronic HIV infection. These findings are important as currently, treatment for people with HIV is often deferred until the CD4 count falls below a certain level (350) or is based on clinical symptoms.

In a study led by Marlous Grijsen from the Academic Medical Center, University of Amsterdam in the Netherlands, 168 patients with primary HIV infection were randomized to receive no treatment, 24 weeks of cART, or 60 weeks of cART. They found that the average viral setpoint (the stable point that is reached in the amount of virus in the blood after the immune system begins to make antibodies to HIV) was lower in the patients who received early cART than in those who had no treatment.

Furthermore, on average, patients who received no treatment started long term treatment with cART before those who received early temporary treatment—0.7 years after randomization whereas those receiving 24 and 60-week treatment restarted cART after 3 years and 1.8 years, respectively.

The authors say: "This randomized study demonstrates a clear clinical benefit of temporary cART initiated during [primary HIV Infection]. Early cART transiently lowered the viral set point and deferred the need for restart of cART during chronic HIV infection."

They continue: "Although extended follow-up studies are needed to evaluate the long-term benefits of such early treatment, starting cART when the patient is ready to do so seems the most reasonable advice for patients with [primary HIV Infection]."

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Funding: This study was investigator-driven and not supported by any sponsor or specific source of funding. The Dutch HIV Monitoring Foundation is funded by The Netherlands government. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Patients with H.I.V. were 96 percent less likely to pass on the infection if they were taking antiretroviral drugs - a finding that is so overwhelming that it is likely to change the way American AIDS doctors treat patients and what treatment policies are adopted by the World Health Organization and other countries, said Dr. Anthony S. Fauci, head of the National Institute of Allergy and Infectious Diseases, which paid for the trial.

The data was so convincing that the trial, scheduled to last until 2015, is effectively being ended early.

There have been previous studies, notably among drug abusers in San Francisco and Vancouver, British Columbia, that concluded that starting patients on drugs immediately would stop them from infecting others.

Those studies led Unaids, the United Nations AIDS-fighting agency, to adopt “test and treat” as its goal last year; the policy encourages doctors to start people on treatment as soon as they test positive for H.I.V. However, this is the first evidence from a randomized clinical trial, the gold standard in medical research.