January 5, 2010

ARV Treatment Cuts Mortality in Early and Late Treaters

Antiretroviral (ARV) treatment cuts the death rate in people with HIV by up to 46 percent, according to a study published in the January 2 issue of AIDS and reported by aidsmap. Even those who didn’t initiate therapy until their CD4 cell counts were below 100 experienced a profound reduction in the risk of death from any cause.

Studies from as far back as 1998 have consistently demonstrated that potent combination ARV treatment can significantly cut the rate of death in people with HIV. However, most studies looked specifically at the reduced risk of death due to AIDS-related complications—not non-HIV-related diseases or others causes of death, including accidents and suicide. What’s more, few studies have looked at “all-cause mortality” rates among those starting ARV therapy with varying CD4 counts.

To determine the impact of ARV treatment on deaths in people with HIV, researchers from the HIV-Causal Collaboration—a network of several large cohort studies—analyzed data involving 62,760 HIV-positive people from five European countries and the United States who were new to ARV therapy and were followed for an average of about three and a half years.

Researchers found significant cuts in the death rates. People who started treatment with CD4 cell counts under 100 had a 46 percent cut in all-cause mortality rates. People who started with CD4 counts above 350 had about a 6 percent reduction in the death rate. The reason for the substantially lower rate of mortality gains among those with high pre-treatment CD4s was a low number of deaths over the short follow-up period among those starting therapy compared with those not on ARV treatment.  

Though the benefits of ARV treatment were greater for people who started treatment with CD4 counts of less than 100, the researchers take pains to stress that waiting to start treatment is not a good idea. “This finding,” the authors conclude, “…does not imply one should delay [ARVs] until the CD4 cell count drops below [100] because, besides the possibility of dying during the waiting period, the five-year mortality risk of treated individuals with less than [100 CD4s] at baseline (11 percent) was almost four times greater than that of treated individuals with more than 500 [CD4] cells (3 percent).”

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