Starting HIV Treatment Sooner Leads to Better Immune Recovery

[Jim Allen]

It is an interesting read, although the results are unsurprising.

POZ.com article: https://www.poz.com/article/starting-hiv-treatment-early-leads-better-immune-recovery

In Brief:

People who start antiretroviral therapy (ART) soon after acquiring HIV are more likely to experience full immune recovery, according to study findings published in the journal AIDS. In fact, each day of delay during the first six months after infection reduced the chances of reaching a normal CD4 T-cell count and CD4/CD8 ratio.

The HEATHER study was an observational cohort of people with documented primary HIV infection who started treatment within three months after diagnosis. They were enrolled at four clinical sites in the United Kingdom. Of the 204 participants, 144 enrolled between 2009 and 2015—before the advent of pre-exposure prophylaxis (PrEP) and universal ART regardless of CD4 count—and 90 enrolled between 2015 and 2020.

Almost everyone achieved a viral load below 200 after starting treatment, with a median time to viral suppression of 115 days. Men and people who used integrase inhibitors as part of their initial ART regimen had a shorter time to viral suppression.

The researchers saw an association between earlier ART initiation during primary HIV infection and increased immune recovery. Over a median follow-up period of 33 months, 47% of participants reached a CD4 T-cell count above 900, and 64% achieved a CD4/CD8 ratio greater than 1.0. (A normal CD4 count in HIV-negative people is between 500 and 1,500 cells.)

Having a lower CD4 count, a lower CD8 count or a lower CD4/CD8 ratio at the time of ART initiation was associated with a longer time to CD4 cell recovery. For every day that treatment was delayed, there was a lower likelihood of achieving a CD4 count above 900 and a CD4/CD8 ratio greater than 1.0.

I have kept updating the "When to start HIV treatment" and the "Welcome to the "I Just Tested Poz" Forum" threads when I spot these types of publications or articles.

https://forums.poz.com/index.php?topic=68419.0
https://forums.poz.com/index.php?topic=2276.0

[numbersguy82]

Interesting…. This can be disheartening for some of us that were diagnosed in the fuzzy time when some doctors thought it was better to wait while others urged immediate treatment. We still have it better than a lot of the earliest patients!

[leatherman]

although the results are unsurprising.

I'm not dissing the authors of this research and study; but I do have a basic rant about these sorts of results.

Treating an illness as soon as possible results in a better long term outcome. No duh! isn't that why doctors hound us about getting colonoscopies? To find illnesses/cancers as early as possible to treat for better long term outcomes?

In the earliest days, PLWH were made to wait for treatment for a variety of reasons:
1. lack of ARVs (the first drugs and combos were just being invented),

2. lack in the supply chain of ARVs (it takes time to get these rarely used meds to pharmacies serving the lesser amount of PLWH in those days),

3. side effects of those early meds (Ok, I could call some of those toxic. I quit ARVS twice in the 90s because I believed the side effects were worse than just dying outright)

4. not to mention funding was less available for the early expensive ARVs.

None of those items should have been an issue for anything but immediate treatment since the earliest of the 2000s

[Tonny2]

             ojo.               Hello everybody!… I guess it’s part of learning new infections. I remember that, even though there were some good medication’s the protocol to start treatment was to get to 200 cd4 levels,  then it is starting to increase it to 350 cid4 levels. I guess, as they say. you learning by spalling. (i’m not sure if this phrase makes sense in English.) it seems like logic, that sooner to treat any illness the result is better. I remember back in the day that people who were dying due to an opportunistic infection due to AIDS, they were dying alone, and Doctor, who were treating the patient they look like astronaut because they were afraid of the new virus. Less, don’t forget the Covid19 virus, everybody was scared, and nobody knew how to behave to be safe, reading the infected ones. And then I always people who think that they know better, always complaining. If I knew then, what I know now I wouldn’t have lost my vision. But anyway, that’s life, and we are going to encounter other viruses and still we will learn little by little. Comprende?

[Jim Allen]

Interesting…. This can be disheartening for some of us that were diagnosed in the fuzzy time when some doctors thought it was better to wait while others urged immediate treatment. We still have it better than a lot of the earliest patients!

I can understand why someone might feel a bit disheartened.  However,  plenty of studies have shown the benefits of ART, longer life expectancy and better outcomes than those before the fuzzy time or with a late diagnosis and this applies to the vast majority of us.... Also with the additional monitoring we get as part of our routine other health issues can be treated or managed well, a benefit many of our HIV negative peers don't have, that's how I see the situation.

The rapid speed of development and change in HIV treatment, understanding and guidelines compared to other illnesses is amazing and prehaps a factor someone might feel more disheartened, but after the START study 2015 and even before that the idea of treating HIV early is best isn't new and a testament to how the drugs have changed over the years.

I think this was also touched on during that conference last month.
https://forums.poz.com/index.php?topic=77637.0

Modern times: The "treat all" "U=U" everything is a "normal" era, and messages/campaigns today do not reflect everyone in the HIV community. The vast lived experience and reality for many PLHIV today are different to this as it also depends on when someone was diagnosed and at what stage. We need to remember this when discussing HIV.

HIV Treatment & Cure: Treatment has come a long way in a short time. Pre-HAART - Hit early and hard -  The wait era - Treat all era. This fast development speed is impressive compared to other conditions, thanks to activists, particularly in the early years. However, don't expect a cure within working lifetime.

Life expectancy. In the era of "treat all" and "U=U" etc., life expectancy is "normal". However, studies into this don't predict an individual's life expectancy—many individual factors.

Treating an illness as soon as possible results in a better long term outcome. No duh! isn't that why doctors hound us about getting colonoscopies? To find illnesses/cancers as early as possible to treat for better long term outcomes?

Yup.

In the earliest days, PLWH were made to wait for treatment for a variety of reasons:
1. lack of ARVs (the first drugs and combos were just being invented),

2. lack in the supply chain of ARVs (it takes time to get these rarely used meds to pharmacies serving the lesser amount of PLWH in those days),

3. side effects of those early meds (Ok, I could call some of those toxic. I quit ARVS twice in the 90s because I believed the side effects were worse than just dying outright)

4. not to mention funding was less available for the early expensive ARVs.

None of those items should have been an issue for anything but immediate treatment since the earliest of the 2000s

Yes, the meds and even understanding of HIV and what's best developed and changed quickly.