A new study entitled “Influence of the Timing of Antiretroviral Therapy on the Potential for Normalization of Immune Status in Human Immunodeficiency Virus 1–Infected Individuals” reports that early intervention with antiretroviral therapy for HIV-1 infection significantly decreases the risk of developing AIDS. The study was published in the November issue of JAMA Internal Medicine.
In this study, the authors aimed to determine how the timing in which individuals infected with HIV-1 impacted in their immune system. For this, they analyzed CD4+ T-cell counts, a type of white blood cell in the immune system that is attacked and destroyed by the HIV virus, to impair the immune system response against the infection.
They analyzed data from U.S. Army, Air Force, Marines and Navy for treatment and outcome with 1,100 soldiers and beneficiaries infected with HIV-1. The authors found that HIV-1 infected individuals if treated with antiretroviral therapy (ART) within 12 months of seroconversion (in immunology, seroconversion denotes the detectable presence of a specific antibody in the blood, while the respective antigens become undetectable) and if at the ART therapy starts their CD4+ T-cell count is above 500 cells per cubic millimeter, then these individuals are capable of reaching a normal CD4+ count when compared to individuals who start Art after 12 months. Additionally, the early intervention with ART also results in improved immune responses (measured by Responses to hepatitis B virus vaccine) and a reduced T-cells activation (previously demonstrated to impact on HIV infection progression).
Thus, the authors highlight the necessity for frequent HIV testing screens and the adoption of prompt ART therapies in positive cases, as an important and crucial public health strategy against HIV.
Sunil K. Ahuja, M.D., professor of medicine, microbiology/immunology and biochemistry in the School of Medicine at the UT Health Science Center San Antonio and the study’s lead author noted, “The immune system can be reconstituted most effectively and durably if ART is initiated quickly after infection. While the practice has been to defer generally ART until CD4+ counts decline to less than 500 cells per cubic millimeter, our results suggest that any delay in ART even in people maintaining higher levels of CD4+ counts impairs their ability to normalize subsequentlyCD4+ T-cell counts.”
Jason F. Okulicz, M.D., study first author added, “Drug regimens have become much more potent, so it is possible to suppress HIV quite easily. We are suggesting that achieving normalization of immunologic health comparable to that of an uninfected person, and making it stick for the long term, is also a critical goal. Conceivably this level of normalization of CD4+ counts will associate with a dampening of the risk for non-AIDS-related diseases we see frequently in our patients.”