Early treatment for HIV can prolong the patient’s life by as long as nine years, say health-care analysts.


John A. Romley, PhD, of the University of Southern California, in Los Angeles and colleagues assessed the effects of early HIV combination antiretroviral therapy (cART) initiation on life expectancy among persons with the disease.

The investigators looked at life-expectancy gains between 1996, when cART was introduced, and 2009, when U.S. guidelines for HIV treatment were revised to recommend cART initiation earlier in the disease course. Early-stage disease was defined as the period when CD4 white blood cell counts were 350 per cubic millimeter of blood or higher.


People who initiated cART treatment early—when their CD4 counts were in the 350-to-500 range—could expect to live 6.1 years longer than persons with late cART initiation, which was defined as cART not administered until the CD4 count fell below 350.

The survival benefit was even greater for the earliest initiators of cART: Persons who began such treatment while their CD4 counts were higher than 500 could expect an additional 9.0 years of life. 


Mortality risk among persons with HIV was found to be 28% higher if cART treatment began when CD4 counts were less than 350 rather than 350 to 500. Mortality risk was 1.16 times higher if cART were started at the below-350 level rather than at the above-500 level.


Separately, Patrick Kiser and colleagues reported in PLOS One that they have developed an intravaginal ring that protected against both HIV and pregnancy in an animal model. The polyurethane ring delivers controlled doses of both the antiretroviral agent tenofovir (Viread) and the contraceptive levonorgestrel (Next Choice, Plan B One-Step). The device is expected to be tested in women soon.


References

  1. Romley JA. Health Aff. 2014;33(3):370-377.
  2. Clark JT et al. PLOS One. 2014;9(3):e88509.