Is early treatment of HIV really that much better?

[rawTOP]

Pulling comments out of another thread…

I have to say I disagree with you about the push towards treatment. Treating people as soon as they are infecting is good for the individual, and the general population. If helps prevent new infections, and keep the infected individual healthier in the long run. While it is up to the individual, its much better for them too.

I'm 1,000 % behind Treatment as Prevention and I fully believe it is the strategy of the future for lowering infection rates. And with PreP added to the arsenal, I don't fear pressure for guys to go into treatment is an issue since guys are going into treatment before infection. I really don't think the issue of the pressure to go on meds will be a significant argument now that meds are what they are now. There is absolutely no medical advantage to waiting. None. Anyone who choses to have bareback sex needs to be on meds. That is HIV prevention, pure and simple. It's 2014 folks.

Can someone please point me to studies, not sponsored by the pharma industry, that show exactly how much benefit poz guys get by starting meds early compared to someone who starts before their t-cells fall below 300? In other words, I recognize that there is a point when you can wait too long (when t-cells drop below 250-300), but I'm questioning immediate treatment vs. slightly delayed treatment. In other words do poz guys really need meds the first couple years they're poz?

And let's concede that going on meds is good for the community in that it will reduce infections. I realize that way of thinking resonates for Europeans, but being a rather individualistic American I'm not the type that will tell someone to go on meds to keep their random tricks neg.

I've heard theories that early treatment may stop HIV from hiding out in the body and make it easier to eradicate HIV completely if such a cure comes along. But taking meds in the hope that a cure might come around some day seems silly. If such a cure comes, who knows whether having taken ARVs early will be necessary for the cure to work.

What I'm looking for is actual reductions in illnesses, complications from illnesses, and actual increases in life expectancy for the person taking the meds early. Does that hard data exist in studies from researchers who aren't funded by pharma companies?

Edited June 11, 2014 by rawTOP

[fillmyholeftl]

RT, I did a search on Poz.com (early treatment benefits) it references several CDC studies. Further searches on other HIV sites like, thebody.com; will show similar results.

[wood]

http://www.webmd.com/hiv-aids/news/20081027/earlier-hiv-treatment-boosts-survival

http://www.aidsmeds.com/articles/WhenToStart_7512.shtml

Recent evidence, however, suggests that mild-to-moderate immune damage earlier in the course of disease, as well as inflammation due to actively reproducing virus, might increase a person's risk for non-AIDS-defining illness such as cardiovascular disease, kidney disease, liver disease and certain cancers. This evidence has prompted experts to recommend treatment earlier than they have done in the past. In fact, HIV treatment is now recommended for ALL people living with HIV in the United States.

http://www.medpagetoday.com/MeetingCoverage/IAS/40268

Antiretroviral therapy can restore aspects of a normal immune system in some patients with chronic HIV, as well as reduce the size of the viral reservoir, a researcher said here.

The catch is they have to start with a relatively intact immune system, with at least 500 CD4-positive T cells per microliter of blood, according to Laurent Hocqueloux, MD, of the Centre Hospitalier Régional in Orleans, France.

Hocqueloux and colleagues have previously shown that treatment early in HIV infection leads to a weak viral reservoir and a good restoration of the immune system.In some patients treated very early, that has led to what the researchers are calling "post-treatment control" -- the ability to go off HIV therapy without having the virus resume growing in the body.

http://www.nyc.gov/html/doh/downloads/pdf/ah/early-hiv-treatment-brochure.pdf

Basically with the medications we have today there is no good reason not to start treatment early. The articles above summarize why. Basically what they say is that by starting treatment early, the person has far less "viral reservoirs" in their body, or places where it is difficult for medication to treat. Additionally starting treatment earlier keeps the immune system much more intact than it would be otherwise. While the immune system generally rebuilds itself in some cases it doesn't happen very easily. Some people who delay the start of treatment never get their CD4 counts back up where they were prior to infection, even with a consistent undetectable viral load.

I posted this a while back.

https://breeding.zone/threads/26212-consistently-low-CD4-count-but-undetectable-any-insight

For some people, who would be considered "healthy" HIV still affects them. I asked an expert later about the guy i posted about above, and he pretty much said that some people's immune system just doesn't function the same after infection. Earlier treatment prevents a large amount of the damage that the unchecked virus can do.

VERY few people can control HIV on their own, and the virus still does a lot of damage without symptoms. Think about other virus's, HPV for example even when latent can eventually cause cancer. Herpes zoster, aka chicken pox can flare up into shingles, etc, etc. HIV is the same. It is damaging and changing a persons body from the moment of infection. There is no "safe time" to have the virus. With that said, because the body adapts, it can rebuild itself with help later, but some damage is irreversible, or can take an extremely long time to reverse.

Another analogy is to make it akin to smoking. A person can be "healthy" and be a smoker, but that doesn't mean that smoking isn't harming them. The same goes for HIV. While the damage may not be immediately apparent, it may become more apparent later in life, in in another time of immune system stress.

I really don't think you will find a drug company agenda in when to start treatment, when people need it, they will get it. and I haven't heard of any drug company pushing for immediate treatment. In fact, even the advertisements usually say things like, "Is your CD4 low or dropping, maybe its time for treatment"

Edited June 11, 2014 by wood

[TigerMilner]

Excellent job Wood with the relevant citations. The way it was explained to me is that you can achieve a "functional cure" if you can kill the virus before it gets into the latent cd4 cells a.k.a. "viral reservoirs" where the virus hides. This is what makes it so difficult to treat. It takes 6-12 months for it to invade these latent cells which is why early treatment is so important. Once that window of time passes, it is closed for good. My doctor thinks I can stop meds after 2-3 years and my viral load will not return from undetectable. I'm at 2 years next month. I'm afraid to test the theory just yet, but I have an appointment on the 29th and we will discuss it. Of course I will still be HIV positive because that test is for antibodies for the virus, which I will always have. That is why the phrase "function cure" is being used. This is HIV today guys. Putting off treatment today benefits the virus, that is all. There is no advantage to waiting.

[Guest thehammerman]

...What I'm looking for is actual reductions in illnesses, complications from illnesses, and actual increases in life expectancy for the person taking the meds early. Does that hard data exist in studies from researchers who aren't funded by pharma companies?

Not quite sure, but this might be interesting to you: http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1003211 It's a French study, fully peer reviewed, on the possible positive effects of receiving early HIV treatment. It appears that, if started soon enough (only a couple of months after infection), some people can be 'functionally cured' of the infection and can come off treatment after about 3 years. A good overview of the study can be read here, on an NHS webpage: http://www.nhs.uk/news/2013/03March/Pages/Early-treatment-may-hold-key-to-HIV-functional-cure.aspx

[Guest thehammerman]

Just found another interesting study in my files - see http://www.nejm.org/doi/pdf/10.1056/NEJMoa1110039 - which suggests that early meds (for 48 wks) slow the damage of the disease to the immune system and delays the need for long-term treatment. A good overview of the study can be read here: http://www.ox.ac.uk/media/news_stories/2013/130117.html