Study: Antiretroviral therapy for HIV-1 in first four months is crucial
Patients who are started on antiretroviral therapy for HIV-1 infection within four months of estimated infection date—and who have higher counts of CD4+ T-cells at the initiation of therapy—demonstrate a stronger recovery of CD4+ T-cell counts than patients in whom therapy is started later, a new study shows.
The report, to be published Thursday in The New England Journal of Medicine, is co-authored by physicians of UT Medicine San Antonio and the University of California, San Diego and drew data from 468 patients followed in the San Diego Primary Infection Cohort. UT Medicine is the clinical practice of the School of Medicine at The University of Texas Health Science Center San Antonio. Co-authors are from the University of California, San Diego School of Medicine, the San Antonio Military Medical Center and Monash University in Australia.
Transient increase, then decline
In the four months after HIV-1 (human immunodeficiency virus type 1) infection, the immune system mounts an immune response toward a temporary restoration of CD4+ T-cell counts; CD4+ T-cells are specialized immune cells that are required to fight infections and are depleted during HIV infection. After this transient increase, the CD4+ count progressively declines. The study, funded by the National Institute of Allergy and Infectious Diseases and other sources, offers insight into the optimal timing of therapy.
"This study suggests greater urgency to start antiretroviral therapy earlier, when the most weapons in the immunity armamentarium are at the body's disposal," co-lead author Sunil K. Ahuja, M.D., said. Dr. Ahuja is professor of medicine, microbiology/immunology and biochemistry in the School of Medicine at the UT Health Science Center and director of the Veterans Administration Center for AIDS and HIV Infection, a national center within the South Texas Veterans Health Care System.
Observation of the transient restoration of CD4+ T-cell counts and their subsequent decline "raised the possibility that after acute infection there may be a narrow 'restorative time window' wherein the immune system could be strategically poised for recovery and that the likelihood and rate of recovery may be augmented by earlier initiation of potent antiretroviral therapy," co-lead author Susan J. Little, M.D., said. Dr. Little is professor of medicine at the University of California, San Diego School of Medicine.
Recovery of CD4+ T-cell counts to approximately normal levels of 900 or more cells per cubic milliliter was observed in 64 percent of participants who were put on antiretroviral therapy (ART) within four months of estimated date of infection, compared to 34 percent of participants in whom ART was initiated later.
"Even a fairly short deferral of ART after closure of this time window may come at the expense of compromised CD4+ T-cell recovery, irrespective of the CD4+ count at the time of treatment initiation," Dr. Ahuja said. "Further studies are needed to determine whether starting ART within the restorative time window promotes strategies that help fully reconstitute the immune system."
Timing of ART
In an accompanying editorial, Bruce Walker, M.D., and Martin Hirsch, M.D., of Harvard Medical School wrote: "The question of when to initiate ART remains a difficult one, particularly in resource-limited settings, but the studies in this issue of the Journal provide strong supportive evidence suggesting a benefit for early therapy." The authors noted that the study relies on a surrogate measure of disease progression, CD4+ T-cell count, rather than on clinical outcomes.
"Future studies of treatment even earlier in the course of infection may show additional benefits, and a population of such patients will be an important study group for eventual studies aimed at 'cure' of infection," Drs. Walker and Hirsch wrote.
Journal reference: New England Journal of Medicine
- New study adds further guidance on when to start antiretroviral therapy for HIV Sep 26, 2011 | not rated yet | 0
- New memory for HIV patients Mar 26, 2012 | not rated yet | 0
- Study examines cost-effectiveness of HIV monitoring strategy in countries with limited resources Sep 22, 2008 | not rated yet | 0
- Combined drug therapy to treat TB and HIV significantly improves survival Feb 25, 2010 | not rated yet | 0
- Only one-third of HIV-positive patients remain in care before starting treatment Jul 19, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
(HealthDay)—For HIV-infected individuals with recurrent Clostridium difficile infection, fecal microbiota therapy is feasible, according to a letter published in the May 21 issue of the Annals of Intern ...
HIV & AIDS 21 hours ago | not rated yet | 0
Canadian health authorities lifted Wednesday what was effectively a ban on gay men giving blood, announcing new rules making men who have not had sex with men in the past five years eligible.
HIV & AIDS 23 hours ago | not rated yet | 1
Top AIDS scientists were optimistic Wednesday of finding a cure for the disease that has claimed 30 million lives—but said it might not work for all people.
HIV & AIDS May 22, 2013 | not rated yet | 0
The integration of mental health interventions into HIV prevention and treatment platforms can reduce the opportunity costs of care and improve treatment outcomes, argues a new Policy Forum article published in this week's ...
HIV & AIDS May 21, 2013 | not rated yet | 0
Chinese and U.S. scientists have used virus isolated from a person who died from H7N9 avian influenza infection to determine whether the virus could infect and be transmitted between ferrets. Ferrets are often used as a mammalian ...
23 minutes ago | not rated yet | 0 |
By discovering the new mechanism by which estrogen suppresses lipid synthesis in the liver, UC Irvine endocrinologists have revealed a potential new approach toward treating certain liver diseases.
38 seconds ago | not rated yet | 0 |
UCLA researchers examining outcomes for advanced heart-failure patients over the past two decades have found that, coinciding with the increased availability and use of new therapies, overall mortality has decreased and sudden ...
4 minutes ago | not rated yet | 0
Aortic arch pulse wave velocity, a measure of arterial stiffness, is a strong independent predictor of disease of the vessels that supply blood to the brain, according to a new study published in the June issue the journal ...
4 minutes ago | not rated yet | 0
Scientists at the National Institutes of Health report they have discovered in mouse studies that a small molecule released in the spinal cord triggers a process that is later experienced in the brain as the sensation of ...
1 hour ago | 5 / 5 (1) | 0 |
Teams of highly respected Alzheimer's researchers failed to replicate what appeared to be breakthrough results for the treatment of this brain disease when they were published last year in the journal Science.
1 hour ago | not rated yet | 0 |