Insufficient Evidence to Support Universal HIV Treatment?

[tednlou2]

Any thoughts? 


"A group of HIV experts believes there is not yet enough evidence to support a recommendation of universal antiretroviral treatment regardless of CD4 levels, aidsmap reports. Publishing their argument in the journal AIDS, a group of researchers from the United Kingdom, Australia and Brazil have critiqued various inconsistencies in several global bodies’ policies on when people with HIV should start treatment. The scientists reason that if these organizations used more exacting standards to rate the evidence on when to start treatment their recommendations would prove more in line with one another’s.

The guidelines discussed in the article include those of the United States Department of Health and Human Services, The International Antiviral Society USA, The World Health Organization (which recently recommended all people with HIV begin ARVs at 500 or fewer CD4s), the European AIDS Clinical Society and The British HIV Association.

The paper’s authors point out that there are no published results from a randomized controlled trial (RCT)—the gold standard of scientific research—that assess the risks and benefits of beginning treatment before CD4s hit 350. Among the four available observational cohort studies (which produce a less sterling form of scientific proof) addressing this concern, just two showed a higher death rate among those starting therapy after the 350 benchmark. Only one study showed a benefit of beginning therapy before CD4s drop below 500.

There are, however, two RCTs currently examining the difference of beginning therapy before or after CD4s fall below 350, with results expected in 2014 and 2016."

http://www.poz.com/articles/early_treatment_761_24456.shtml

[Jeff G]

Its good that the article points out that there are some very good reasons why an individual should or could choose early treatment if its right for them .

Can a study factor in the human reasons for early treatment ?

[Ann]

I'd highly recommend that people read the more comprehensive article on aidsmap.com, rather than only reading the quicky version on poz.com. (Nothing wrong with the quicky version, but the aidsmap article is much more informative.)

http://www.aidsmap.com/Evidence-is-not-yet-sufficient-to-recommend-universal-treatment-clinicians-and-community-writers-say/page/2718639/

[buginme2]

Can a study factor in the human reasons for early treatment ?

Study, Study, Study and this article shows how two similar studies can show different results.  The NA-ACCORD study showed a benefit starting early (94% less likely to die if starting >500 cd4 count yet the CASCADE showed no benefit). 

How about the individual benefit?  At this point I don't care what any other study says on this subject.  I know for me, myself, and I....I feel better on treatment than off treatment and am 110% happy that I started when I was diagnosed versus waiting, 

Bottom line, I feel better.....a lot better (and my numbers weren't "bad").  I'm 96 percent less likely to transmit to my partner.  I feel better, look better, happier, and 96% less likely to transmit to my partner. 

Kind of surprised that we are still having this conversation.

Edited to add;  I'm kind of concerned that people who have been told to start treatment by their doctors see these discussions and think "I can wait."  Or they are hoping that they can wait because its not proven one way or another.   People still die from untreated HIV and even untreated hiv at higher cd4 counts still leads to things like cancer, heart disease, liver and kidney disease etc etc etc.  just a thought

[jkinatl2]

I am biased, I suppose, but I am totally for starting treatment upon diagnosis if possible (access to meds and treatment, psychological and physical ability to adhere to meds). Not only does it preserve the innate immune system AND render the person far less infectious (TAP) but almost everyone on these forums says that starting treatment gives them a feeling of empowerment over the virus, rather than waiting while it eats enough of the immune system away to warrant a doctor's suggestion.

That empowerment cannot be overstated, as I firmly believe it helps a person adjust to the diagnosis and take back control over his/her life.