Study: People with HIV start treatment too late

Photomicrograph image of Azido-thymidine (AZT), a retroviral commonly used to slow the progression of HIV. National Cancer Institute

Analysis of treatment outcomes for newly diagnosed HIV patients found that many people in the United States and Canada are starting antiretroviral therapy later than current guidelines recommend. These delayed treatments had less favorable results, according to a study published in Clinical Infectious Diseases.

A 10-year study of nearly 45,000 HIV-infected people in the United States and Canada confirmed that the earlier people are diagnosed and initiate treatment, the better their treatment outcomes. But despite the evidence that earlier HIV diagnosis and treatment leads to better outcomes, there was a trend toward delayed treatment in both countries over the study period, according to researchers at Johns Hopkins University School of Medicine, Baltimore, and 16 collaborating institutions in the United States and Canada.  Their research is published in the June 1 Clinical Infectious Diseases. 

Researchers analyzed patients' CD4 cell counts, a critical measure of immune system strength, when these patients first began clinical care for HIV from 1997 to 2007. Although the median CD4 count at first presentation increased annually over this period, from 256 cells/mm3 to 317 cells/mm3, it remains below the level currently recommended for patients to start antiretroviral therapy, 350 cells/mm3. The median age at which patients first received HIV care increased over the study period from 40 to 43 years of age.

"The public health implications of our findings are clear: Delayed diagnosis reduces survival, and individuals enter into HIV care with lower CD4 counts than the guidelines for antiretroviral therapy initiation," said study author Richard Moore, MD, of Johns Hopkins. "A delay in presentation for treatment not only increases the chance of clinical disease progression but also increases the risk of ongoing transmission."

In a related editorial, Cynthia Gay, MD, University of North Carolina at Chapel Hill, commented, "These findings reveal that despite such compelling data, there is much room for improving our ability to link more HIV-infected individuals with effective treatment prior to immunological deterioration."

Citations:

Clinical Infectious Diseases 2010;50:1512–1520, DOI: 10.1086/652650

Clinical Infectious Diseases 2010;50:1521–1523, DOI: 10.1086/652651