A study has found that starting antiretroviral treatment (ART) with a CD4 count of 500 or more within the first year of contracting HIV results in measurable and significant immunological benefits. Whereas waiting for CD4 counts to fall before starting treatment decreases the likelihood of immune restoration.
US researchers studied 1,119 people living with HIV who had an estimated date of seroconversion (EDS). Those on ART within a year of infection reached a normal CD4 level — considered to be around 900 in the general population — in almost 40% of cases compared with about 30% of those who began ART 12 months or more after EDS.
Researchers found that participants had “the capacity for CD4 cell normalisation” if the duration of untreated HIV infection is minimised; and even greater capacity if the CD4 count when ART was initiated was 500-plus. Delaying the initiation of ART beyond 12 months of EDS, concluded the researchers, “diminishes the likelihood of restoring immunologic health in HIV-1-infected individuals”.
The study chimes with what has long been suspected: treating early better positions PLHIV to directly fight off infections, tumours and disease. Early treatment can also result in an undetectable viral load, which has the potential to dramatically reduce the risk of passing on HIV to a regular sexual partner (this is particularly reassuring news for people whose sexual partners are HIV negative).
Another survey has found the benefits of early ART were jeopardised if treatment was later interrupted. Those who started on ART early and maintained treatment adherence held an average CD4 count of 731; while those who interrupted treatment had an average count of 625.