Vancouver, BC [August , 2015] A new study finds patients who start HIV combination antiretroviral treatment (cART) at high CD4 levels – when the immune system is still healthy – have higher likelihood of long-term adherence and better clinical outcomes. Published in the journal AIDS, the new research confirms, at the population level, the results of recent randomized clinical trials supporting immediate initiation of HIV treatment.
“Our study counters concerns among clinicians that individuals living with HIV will not feel compelled to stay on treatment because they are asymptomatic or are feeling fine,” said lead author Dr. Viviane Dias Lima, Research Scientist and Senior Statistician at the BC Centre for Excellence in HIV/AIDS (BC-CfE).”Improved patient support and education, as well as the availability of simpler and better tolerated HIV drug regimens, are likely contributors to the observed higher adherence and better outcomes.”
The study’s main findings:
- Individuals who start cART early are more likely to suppress the virus over time and maintain adherence levels over 95 per cent.
- Individuals who start treatment at higher CD4 counts have the lowest probability of mortality and are less likely to develop drug resistance.
- Between 2007 and 2012, comparing individuals with high and low CD4 counts on cART, the probability of mortality was lower amongst those with high CD4 at cART initiation.
- Probability of loss to follow-up was lower among individuals with high CD4 starting cART in the most recent years, in comparison to the same group of individuals in previous years.
The findings support the BC-CfE’s long-held position that early engagement into treatment and sustained care significantly improves health outcomes for individuals on cART, while decreasing HIV transmission. The recent international Temprano and START clinical trials found immediate HIV antiretroviral therapy results in less serious illness and AIDS-related deaths, compared with deferred treatment. Dr. Lima’s study shows the effectiveness of early treatment within a real-world environment.
Within British Columbia, Treatment as Prevention¨ (TasP¨)-based strategies (providing facilitated and immediate access to antiretroviral treatment) offer treatment at no cost to patients. This setting provides a unique cohort to study treatment outcomes as all patients have access to the same antiretroviral options, medical care, and laboratory monitoring. TasP¨ within BC has resulted in an 83 per cent decrease in AIDS-related deaths since 1994.
The international research community has come on board with early HIV treatment. In July 2015, the World Health Organization released new guidelines supporting the immediate offering of antiretroviral therapy, regardless of CD4 count. That same month, delegates and leaders signed on to the Vancouver Consensus at the International AIDS Conference, also calling for the provision of immediate treatment to those diagnosed with HIV.
“This study shows a strong association between higher CD4 count at initiation of antiretroviral therapy and improvement in all investigated health outcomes,” said Dr. Julio Montaner, Director of the BC-CfE.”Providing those living with HIV with immediate access to the most effective treatments can dramatically improve lives, while leading to an end to AIDS. TasP¨ provides a critical roadmap to reaching these goals.”
UNAIDS created a strategy to end AIDS by 2030, based on the principles of the made-in-BC TasP¨. UNAIDS 90-90-90 aims to diagnose 90 per cent of those living with HIV worldwide, to have 90 per cent of those diagnosed on treatment, and to have 90 per cent of those on treatment virally suppressed by the year 2020.
About the British Columbia Centre for Excellence in HIV/AIDS
The BC Centre for Excellence in HIV/AIDS (BC-CfE) is Canada’s largest HIV/AIDS research, treatment and education facility and is internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases. BC-CfE is based at St. Paul’s Hospital, Providence Health Care, a teaching hospital of the University of British Columbia. The BC-CfE works in close collaboration with key provincial stakeholders, including government, health authorities, health care providers, academics from other institutions, and the community to decrease the health burden of HIV and AIDS. By developing, monitoring and disseminating comprehensive research and treatment programs for HIV and related illnesses, the BC-CfE helps improve the health of British Columbians.
For additional information or to request interviews, please contact:
Caroline Dobuzinskis, BC-CfE
Cell: 604-366-6540
Phone: 604-682-2344 ext. 66536
Email: cdobuzin@cfnet.ubc.ca
Additional media resources available online.
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