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Benefits Seen With Early Antiretroviral Therapy in HIV

Last Updated: July 14, 2010.

Early initiation of antiretroviral therapy in HIV-infected adults with CD4+ T-cell counts below 350 per cubic millimeter may lower the rates of death and new cases of tuberculosis, according to research published in the July 15 issue of the New England Journal of Medicine.

WEDNESDAY, July 14 (HealthDay News) -- Early initiation of antiretroviral therapy in HIV-infected adults with CD4+ T-cell counts below 350 per cubic millimeter may lower the rates of death and new cases of tuberculosis, according to research published in the July 15 issue of the New England Journal of Medicine.

Patrice Severe, M.D., of the Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes in Port au Prince, and colleagues analyzed data from 816 HIV-infected adults with a CD4+ T-cell count greater than 200 and less than 350 per cubic millimeter at baseline, and no history of AIDS illness. They were randomized to receive therapy with zidovudine, lamivudine, and efavirenz either within two weeks of enrollment or when their CD4+ count dropped to 200 or less or they developed clinical AIDS.

The researchers found that, over a median 21 months of follow-up, 23 died in the standard group compared to six in the early-treatment group (hazard ratio for standard treatment, 4.0). The standard group had 36 incident cases of tuberculosis, compared to 18 in the early-treatment group (hazard ratio, 2.0).

"In conclusion, early antiretroviral therapy decreased the rate of death by 75 percent in HIV-infected adults who had a CD4+ T-cell count that was greater than 200 and less than 350 per cubic millimeter. Access to antiretroviral therapy should be expanded to all HIV-infected adults who have a CD4+ T-cell count of less than 350 per cubic millimeter, including those who live in locations with limited resources," the authors write.

Support for antiretroviral medications was provided by GlaxoSmithKline and Abbott.

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