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Treating HIV Infection, The Earlier The Better

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Author: David S. Weiss, Ph.D. | Category: Of Interest | December 09, 2014

The year was 1981 and I was a laboratory technician at the Memorial Sloan-Kettering Cancer Center.  I was performing Natural Killer Cell Assays on the blood of patients with a most curious, ravaging disease that was killing, primarily, homosexual men. Although not yet understood, or named, this curious disease later became known as HIV/AIDS. 

Many of the generation will remember the fears and resulting international cooperative that was assembled to understand and battle this relentless pandemic. While these fears have subsided, to some extent, with the advent of potent anti-retroviral therapy (ART) that effectively suppresses viral replication, the disease persists. Research is now focused on how to cure HIV and help restore the ravaged immune system back to normal levels.

Just recently, a major step in research was taken towards the treatment of HIV infection led by our own Dr. Sunil Ahuja, a world leader in HIV/AIDS research. Dr. Ahuja and colleagues published their seminal findings in the November 24th issue of JAMA-Internal Medicine (http://archinte.jamanetwork.com/article.aspx?articleid=1939372). This remarkable study examined treatment outcomes data of more than 1,100 soldiers and beneficiaries that were diagnosed with HIV-1. They indexed patients according to how soon they started therapy after infection and according to the levels of the immune-fighting CD4+ T-cell counts before therapy was commenced. The findings in this study is that starting therapy within 12 months of seroconversion (the time in which antibodies becomes detectable in the blood) and at CD4+ counts above 500 cells per cubic millimeter, greatly enhances the likelihood of normalizing CD4+ counts to 900 cells per cubic millimeter, the average levels found in HIV uninfected persons. They also showed that normalization of CD4+ counts on therapy was associated with a negligible risk of developing AIDS as well as near-normal or partial reversion of immune perturbations such as T-cell activation, dysfunction and unresponsiveness.

The importance of this study was emphasized in a press release from the office of Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. (http://www.niaid.nih.gov/news/newsreleases/2014/Pages/ARTtiming.aspx).

“While the practice has been to generally defer ART till 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 subsequently normalize CD4+ T-cell counts,” Dr. Ahuja said.

“This study reinforces the principle of early treatment of HIV disease by demonstrating that this is not only a good policy for the epidemiology of the disease, but confers benefit on the patient as well“ said Dr. George Crawford, Professor of Medicine in the Divisions of Infectious Disease and General Internal Medicine at the UT Health Science Center.

“This important study reminds us that the goal of HIV therapy should be full restoration of immune function and not just suppression of viral replication,” said Timothy W. Schacker, MD, of the University of Minnesota in an editorial in the same issue.

Dr. Robert Clark, a collaborator on this project, had the following to say about this study.  “The optimal time for initiation of anti-retroviral drug therapy in HIV-infected patients has long been debated. This study strongly supports the concept of early therapy by demonstrating how it improves clinical outcomes and substantially enhances the normalization of immune function. At the same time, it underscores the need for novel interventions that will target immune system restoration even more effectively.” 

“These studies also reflect a wonderful long-standing collaboration between investigators at the Veterans Administration and the UT Health Science Center and those at the San Antonio Military Medical Center,” Dr. Ahuja said. “I have cherished this scientific partnership and I am blessed to have such a terrific team of collaborators and colleagues.”

The first author on this study, Dr. Juan Okulicz, is the director of the HIV Medical Evaluation Unit at the San Antonio Military Medical Center and provides HIV care for all active-duty Air Force members. He also oversees HIV care for Army and Navy members, retirees and military beneficiaries. Dr. Ahuja is the President's Council/Dielmann Chair for Excellence in Medical Research, Professor of Medicine, Microbiology/Immunology and Biochemistry, Director, Research Enhancement Programs, VPR Office, UTHSCSA, and the Director, Veterans Administration Center for Personalized Medicine, STVHCS.

For more information about AIDS and AIDS related research visit, http://aidsinfo.nih.gov.



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