Two new studies position themselves in favor of early antiretroviral treatment for HIV, which prevents opportunistic infections.
After preventive treatment, it is the early management of HIV that confirms its effectiveness. Two studies were presented to the International Conference on HIV Pathogenesis, Treatment and Prevention (Vancouver, Canada, July 19-22), organized by the International AIDS Society. Simultaneously published in the New England Journal of Medicine, they confirm that administering antiretrovirals as soon as they are diagnosed reduces the risk of illnesses whether or not linked to AIDS.
START clinical trials (Strategic Timing of AntiRetroviral Treatment) and TEMPRANO both have the same goal: to determine whether prescribing antiretrovirals before the AIDS virus has affected the immune system helps prevent opportunistic or unrelated infections.
Avoid cancer and cardiovascular disease
To date, the World Health Organization (WHO) recommends waiting until CD4 + lymphocytes are at a low level (350 cells / mm3 blood) to start antiretroviral therapy. But initiate it when they are at a normal level (500 cells / mm3) is clearly beneficial for HIV-positive patients. After three years of follow-up, START test leads to the conclusion that this approach reduces serious AIDS-related events, such as opportunistic infections, by 72%. It also reduces non-HIV related health problems by 39%. These are mainly cancers, cardiovascular disease and kidney or liver disease.
“The sooner we treat, the more we protect the immune system from its destruction, the more we help it to restore itself. In fact, treating early protects against the development of AIDS. With such a solid argument as the START and TEMPRANO trials, we can no longer deny it. We know that the drugs will work and that the patients will take them. We can no longer go back, ”analyzes Christine Rouzioux, virologist at Necker hospital (Paris) and member of the study group for the TEMPRANO trial, contacted by Why actor.
Recommendations will change
As the population included in the study is particularly young (36 years median age), a longer follow-up will be necessary to say with certainty that antiretrovirals reduce the risk of cancer, which increases with age. “This study was long enough to gather significant evidence on early initiation of treatment, but three years is a relatively short duration compared to lifelong treatment,” recalls Fred Gordin, co-author of the ‘study.
The French TEMPRANO trial, conducted by the National Agency for Research on AIDS and Viral Hepatitis (ANRS) in Côte d’Ivoire, observed the impact of early treatment on the risk of tuberculosis, which is very high in this country. Antiretrovirals given early actually reduce the likelihood of getting it … just like isoniazid (standard anti-tuberculosis drug).
To avoid complications, it is therefore best to administer antiretrovirals when patients still have a normal level of CD4 + lymphocytes. A scientific consensus that the WHO should take into account: an update of the treatment recommendations should be announced, during the conference.
There remains a major problem: access to the best antiretrovirals must be guaranteed to all populations. In low-income countries, this imperative is far from assured, as the recent UNAIDS report highlighted. On this subject, Christine Rouzioux is quite pragmatic: “Ban Ki-Moon said that it would take 30 billion dollars per year for everyone to be treated, and it will be necessary to treat for a long time. How will the world view this need? As long as you don’t ask the question, you can’t answer it. We are going to ask more of the States, ”she admits. But this virologist is hopeful that with the support of organizations like UNAIDS and more political involvement, this goal can be achieved.
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