Study Finds Another Reason to Stay on Your Meds

Experts want to connect people with HIV with care as quickly as possible, especially since early treatment has been shown to provide long-term advantages.

But a new French study indicates that any immune recovery benefits gained by starting antiretroviral medications may be lost if treatment is interrupted. In fact, the study found little or no difference in terms of immune reconstitution between those who had started treatment immediately and later stopped for a time and those who didn’t start treatment until their CD4 cell counts fell below a certain figure.

The findings, published in the journal AIDS, suggest that only combining early treatment with continuous lifetime adherence gives patients the best hope of reaching a near-normal CD4-to-CD8 ratio. CD4 cells, also known as “T-helper” cells, play a key role in launching the body’s immune response to an infection. In contrast, CD8 cells, or “T-suppressor” cells, help kill off infected cells. Healthy HIV-negative people tend to have more CD4s than CD8s, meaning their CD4-to-CD8 ratio is greater than 1.0, while those with HIV typically have ratios below 1.0.

The researchers looked at HIV-positive people who were part of the PRIMO cohort study and were receiving treatment at the time. The patients in the study fell into three groups:

• 34 percent (244 people) started treatment, on average, less than two months after infection. More than half of those had only one treatment interruption, while 47 percent had more than one.
• 30 percent (218 people) did not start taking antiretroviral medications until an average of two and a half years after infection.
• 36 percent (265 people) started treatment shortly after contracting HIV and remained on it continuously.

The study found that those who began treatment quickly and remained on it continuously had an average CD4 count of 731 cells, 125 cells more than those in the deferred treatment group and 106 more than those who started treatment early but interrupted it.

Those who received treatment early and stayed on it continuously also had higher CD4-to-CD8 ratios than those in either of the two other groups. A full 64 percent of them had a ratio greater than 1.0, in contrast to 40 percent of those who deferred treatment and 36 percent of those who interrupted it. These results held true even after controlling for factors including treatment duration, sex, and age.

“While most people prescribed [antiretroviral therapy] eventually develop a near-normal CD4 count, only those who started treatment soon after infection, who have continued it ever since and remained undetectable stand a more-than-even chance of achieving an immune system where the balance of T-lymphocytes resembles that of a person without HIV in terms of their CD4:CD8 ratio,” notes AIDSMap.

The researchers say their study’s results underline the critical need to get into treatment early and to adhere to medication in order to limit cumulative HIV viremia (the amount of HIV in the bloodstream) and achieve the best possible degree of immune-system recovery, notably the CD4-to-CD8 ratio.

But this does not mean that there is no point in starting treatment early or in returning to it after going off. While continuous treatment is better, this study’s findings reiterate that antiretroviral treatment is key to the immune system’s health.