Immediate antiretroviral therapy for those who have recently been infected with HIV seems to be more effective than deferring treatment in controlling disease progression and in avoiding the need for long-term HIV treatment in later stages, researchers found.
In a study of immediate versus deferred treatment, researchers from the Medical College of Wisconsin found that half of the patients who had waited until they met clinical guidelines to receive treatment required treatment on medical grounds within 18 months.
On the other hand, only 11 percent of patients who had immediate therapy and had an intended interruption after nine months required treatment in the remaining nine months, according to Dr. Christine Hogan, MD the lead author for the study published in the Journal of Infectious Diseases.
Hogan wanted to find out the effect of a period of immediate treatment versus delayed therapy on the virologic set point, the point at which the amount of HIV in the blood levels off in the absence of medication which is generally accepted to be related to the severity of the disease.
However, researchers reported that the study was discontinued earlier than they expected because of the surprisingly rapid rate of viral progression in the deferred-treatment group which made it impossible to calculate the difference in set points between the groups.
Still, the high rate of progression is a “compelling” finding because that further enhances the evidence that earlier treatment in people who have just been infected with HIV is better than deferred treatment, researchers said in the study.
Researchers concluded that "if immediate therapy is not begun, progression to meeting standard criteria for ART initiation may occur more rapidly than expected, especially with changing treatment paradigms."
The study observed 130 men and women who had been infected with HIV within the last six months and had not previously taken HIV medication. The participants included 25 in United States sites and two in Peru.
Participants were randomly selected to be a part of one of the two groups. One group received immediate ART (a fixed-dose combination of emtricitabine-tenofovir plus lopinavir-ritonavir) for 36 weeks and stopped treatment afterwards. The other group had no treatment.
Investigators compared the immediate ART group’s virologic set point with the deferred group virologic set point 72 weeks later and also the immediate treatment group’s average viral load (virologic setpoint) at 72 weeks with the deferred group’s average at 36 weeks.
Dr. Harout Tossonian and Dr. Brian Conway wrote in an accompanying editorial piece, that “An initial 36-week course of treatment at presentation may delay the need to restart treatment for longer than those 36 weeks. Thus, over the lifetime of the patient, there will be less cumulative drug exposure,” according to the piece, which is beneficial in decreasing the risk of infecting others as proven by the HPTN052 trial and will probably benefit overall health prognosis.
Tossonian and Conway also note that “it is often not possible or medically indicated to start taking medications at first presentation. But the discussion can now be framed in an evidence-informed manner," however even if the assessment is to delay therapy, they argued, it is likely to be needed within the next 18 months, so the approach should be to actively plan for it ... from the very beginning."