Patients should start taking drugs for the Aids virus earlier to have the best chance of survival, researchers say.
An analysis of more than 45 000 people with HIV in Europe and North America found they were 28 percent more likely to develop full-blown Aids or die if they deferred treatment until the point currently recommended in many countries.
There is no cure for the human immunodeficiency virus (HIV) that causes Aids, but combinations of drugs can keep the virus from replicating and damaging the immune system.
Doctors normally don't start treatment until there is some evidence of damage to this system, measured by counting the number of immune cells called CD4 T-cells.
Current guidelines in most countries call for treatment only after the CD4 count falls below 350 cells per microlitre of blood.
In the South African public health system treatment is only initiated at counts of 200 cells or lower.
Jonathan Sterne from Britain's University of Bristol and colleagues found waiting until the CD4 had fallen to 251-350 was associated with a significantly worse outcome than starting therapy in the range 351-450.
The team - whose findings were published online by The Lancet journal - concluded that a count of 350 cells should be the minimum threshold for starting treatment.
“While some researchers say that our antiretroviral treatment programme is sub-optimal because we should be starting people on treatment when their CD4 count is 350 not 200, this has enabled us to put almost 700 000 people on treatment in five years,” health minister Barbara Hogan was recently quoted as saying by Health-E.
A balancing act
Deciding when to start taking Aids drugs has traditionally been seen as a balancing act, since the powerful medicines can have serious side effects and there is also a risk of developing resistance.
Researchers said these problems were now easier to deal with, thanks to the advent of a wider range of drugs, and medics should therefore focus on getting patients onto therapy early.
"It is important that people at possible risk of having HIV get tested regularly so that, if found to be infected, they can receive the necessary care and treatment," they said.
An estimated 33 million people globally are infected with the Aids virus. – (Reuters Health, April 2009)
Early HIV treatment best