Important note: Information in this article was accurate in March 2000. The state of the art may have changed since the publication date.
Combination therapy with anti-HIV drugs, particularly protease inhibitors, has greatly reduced cases of HIV-related illness and death in North America, Western Europe, Australia and New Zealand. Although combination therapy has been available for several years, many unresolved issues remain, including the best time to begin therapy and the question of long-term toxicity. Some doctors believe in the "hit hard and hit early" approach to treatment. Given the current understanding of HIV infection and the difficulty finding a cure, such an approach may not be the most appropriate.
To investigate the issue of early versus delayed therapy, researchers in Switzerland have studied their database containing information on more than 10,000 people with HIV/AIDS. This database is the result of an ongoing study that began in 1988. The researchers examined data on more than 2,000 subjects who had used Highly Active Antiretroviral Therapy (HAART). This type of regimen usually includes a protease inhibitor or a drug such as nevirapine or efavirenz. According to their analysis, delaying the use of HAART did not increase the risk of developing AIDS over a period of three years.
Researchers analysed data on 2,285 subjects who had used HAART. At the time they entered the study, subjects had the following features:
On average, most subjects were monitored for about three years.
Overall, about 10% of the group developed a new AIDS-related illness during the study. Women were just as likely to develop AIDS as men. As well, injection drug users were as likely to develop AIDS as men who had sex with men.
Those subjects who entered the study with a diagnosis of AIDS were four times as likely to develop a new AIDS-related condition over a period of three years, compared with subjects who were still in the symptom-free stage of HIV infection. This difference was statistically significant; in other words, not likely due to chance alone. Factors associated with the development of AIDS were therefore:
Details were not provided by the researchers.
Most important, the researchers found that delaying therapy over a three year period did not result in a more rapid progression to AIDS. It will be interesting to see if other studies reach similar conclusions.
In an often cited study published in the New England Journal of Medicine in 1998, the authors compare survival rates from the pre-protease era to the years since the introduction of these drugs. That study also showed that delaying therapy until CD4+ cells fall below 100 cells "results in impressive benefit."
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