Talking early treatment issues

published on September 15, 2015 by Bob Leahy - Editor, in Positive Lite.com

Bob Leahy talks with the world's leading treatment as prevention advocate, B.C.'s Dr. Julio Montaner, about new research that broadens the case for early treatment – and why Canada still needs to fully embrace its benefits.

Vancouver, BC [September, 2015] A new study finds patients who start HIV combination antiretroviral treatment 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 ART 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 ART, the probability of mortality was lower amongst those with high CD4 at ART initiation.

Probability of loss to follow-up was lower among individuals with high CD4 starting ART in the most recent years, in comparison to the same group of individuals in previous years.

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Bob Leahy: Hello Julio, thanks for talking to PositiveLite.com again. Now this new research from B.C is really interesting because we already know, particularly from START and Temprano about some of the real benefits of starting treatment early but now there are a few more that have been established. And I’m thinking that adherence is quite an important one. What’s your take?

Julio Montaner: Let me put this into context for you. There has been ongoing controversy as to whether or not patients who are asymptomatic and have a high CD4 count would be willing and able to adhere to and benefit from antiretroviral therapy in the long term. The argument was that if you are not driven by the urgency of CD4s or the like you would be unlikely to take treatment on a long-term basis. So while our feelings, based on the available literature, were known, we decided to conduct an analysis taking advantage of the fact that we have been offering treatment to people regardless of CD4 count in B.C. for a very long time. We basically showed that people who started treatment with very high CD4 counts were both willing and able to remain in treatment, even though they have occasional blips, as you would expect, from time to time.

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Treatment as Prevention®

Julio Montaner

BC Centre for Excellence in HIV/AIDS

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Talking early treatment issues

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