HIV-positive patients who don’t seek medical attention until they have a serious AIDS-related condition can reduce their risk of death or other complications by half if they get antiretroviral treatment early on, according to a new multicenter trial led by researchers at the Stanford University School of Medicine.
The study results could lead to widespread changes in treatment for HIV patients, particularly those diagnosed at an advanced stage, experts say.
“Even in San Francisco, one of the first epicenters of HIV in the United States, we still find that many people still present late in the course of their illness with an opportunistic infection,” said Mitch Katz, MD, San Francisco’s director of health, who was not involved in the study. “This study shows that it is life-saving to treat those persons with antiretroviral drugs while they are still in the hospital. The results of this study will change practices throughout the world.”
Some 60,000 to 70,000 newly HIV-infected individuals are identified every year in the United States, according to recently revised figures from the federal Centers for Disease Control and Prevention. A growing number of these patients, particularly minorities, youth, injection-drug users and those in poor rural areas, are being diagnosed late in the disease process when they’ve already developed life-threatening conditions, said Andrew Zolopa, MD, associate professor of infectious diseases and geographic medicine at Stanford and first author of the study. When these patients come for treatment of these complications, doctors are often reluctant to give them anti-AIDS drugs at the same time, fearing the two therapies could interfere with one another.
“A lot of people wait, thinking, ‘Let’s get the patient out of acute crisis, and then we’ll deal with the underlying HIV infection later,’” said Zolopa. “But that answer is wrong. If we’re more aggressive with HIV drugs, we can reduce AIDS-related complications and death by 50 percent. It’s a substantial clinical benefit.”
The study was conducted by the AIDS Clinical Trials Group, the world’s largest clinical trial organization. Results will be published May 18 in the online journal PLoS-ONE.
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