New research says it's best to start AIDS therapy early

From staff and wire reports

ATLANTA -- Patients with the AIDS virus are better off if they start taking powerful medicines early, rather than waiting for symptoms of their disease to appear, new research suggests.

A new study calls into question guidelines that say patients should delay taking the toxic drugs to stave off treatment-related complications.

The research focused on "drug cocktail" combinations of three or more drugs. The regimens have become a standard treatment in the last decade, but are associated with such complications as kidney failure and a hand- and foot-numbing condition called peripheral neuropathy.

Federal health officials advise patients to delay this treatment until they develop severe symptoms or the infection causes their natural armament of certain white blood cells to dip below a certain level.

But the researchers found that patients who began taking the drugs early, and took them continuously, developed 28 percent fewer cases of kidney failure and peripheral neuropathy.

"That means one quarter of these cases could be avoided," said Dr. John T. Brooks of the federal Centers for Disease Control and Prevention, one of the scientists who worked on the study.

While the disease has fallen out of the national spotlight, new cases of HIV continue to occur throughout the U.S., including Southeast Missouri.

Fifteen new cases were reported in a 20-county region in Southeast Missouri in 2003 -- the latest year for which data is available -- according to the Missouri Department of Health and Senior Services.

"Infections are still occurring, and any infection is one too many," said Charlotte Craig, director of the Cape Girardeau County Public Health Center.

A total of 428 people living in Southeast Missouri were diagnosed with HIV/AIDS between 1985 and 2003.

Eighty-three of those diagnoses have come from Cape Girardeau County, including three in 2003.

The findings of the new study were presented Tuesday at a scientific conference in Denver. Dr. Kenneth Lichtenstein of the University of Colorado Health Sciences Center led the research.

"The intuitive thing to think is ... the longer you're on the drug, the greater the toxicity," Lichtenstein said. "The surprise in our study is if you didn't develop toxicity in the first six months to a year, your risk of toxicity went down, rather than up."

The researchers examined the medical records of 2,304 patients with HIV in eight U.S. cities.

They placed patients into five groups based on their white blood cell counts, an indication of how sick the patients were.

The researchers compared the risks of kidney failure and the numbing condition for patients with varying white blood counts.

For both side effects, the risk was about 28 percent lower for the patients who started treatment early, before their cell counts dropped, Brooks said.

The study did not attempt to separate out the effect of specific drugs. The work is being prepared for submission to a peer-reviewed journal, but has not been published yet.

The findings argue for early HIV testing and treatment, Brooks said, but "I don't think anyone is ready to recommend changing the guidelines based on a single report."