HIV treatment – when to start
Starting HIV treatment when your CD4 cell count is around 500 has only minor additional benefits, compared to starting treatment with a CD4 cell count of 350, Australian researchers have reported.
There’s a lot of debate about the best time to start HIV treatment. Current British guidelines recommend that you should start treatment when your CD4 cell count falls to around 350. Anyone who is ill because of HIV is recommended to start taking treatment.
Given that HIV treatment requires a high level of adherence and is a lifelong commitment, it is important that people starting treatment feel ready to do so. Understanding the benefits of starting treatment earlier than currently recommended is important for doctors and patients when making decisions about when to start.
Some doctors favour earlier treatment, and there’s research showing that starting therapy at a CD4 cell count of 500 or above reduces the risk of illness and death compared to waiting until later.
A major study is currently underway comparing long-term outcomes in people who start treatment at different CD4 cell counts. Its results – due in 2015 – should clarify this important issue.
The latest research showed that earlier treatment was associated with only modest additional benefits. Starting treatment at a CD4 cell count above 500 didn’t mean that CD4 cell count increases were better in the long term.
Nevertheless, people whose CD4 cell count was above 650 at the time they commenced therapy had a lower risk of developing a new AIDS-defining illness or dying than people whose CD4 cell count was in the 350 to 500 range at the start of treatment.
It’s already very clear that starting treatment with a CD4 cell count of around 350 reduces the risk of HIV-related illnesses as well as heart, liver and kidney disease, and some cancers. At the moment, people with an increased risk of these illnesses are especially encouraged to start treatment when their CD4 cell count reaches 350.
Hepatitis C – training primary care providers
Many people with HIV are also infected with hepatitis C virus (known as ‘co-infection’). Liver disease caused by hepatitis C is a key cause of serious illnesses and death in people with both viruses.
All people with HIV require specialist care, and the care for people with hepatitis C will also involve specialists in liver disease.
Currently, treatment and care for hepatitis C – like HIV – is provided at specialist hospital clinics. GPs (primary care providers) have an important role in looking after other day-to-day health needs.
The research was conducted in New Mexico where many hepatitis C patients live a long way from the hospital clinic, or are in prison.
Therefore doctors at the specialist clinic trained and supported primary care providers to deliver treatment and care services.
Treatment success rates were just as good for patients looked after by GPs as those for people cared for at the specialist clinic.
The researchers are hopeful that their care model could be extended to other disease areas.
Hepatitis C – treatment success
New research shows that drinking three cups of coffee a day increases the chances of hepatitis C treatment working. Treatment is available for hepatitis C, but it doesn’t always work.
It’s already known that drinking coffee is associated with improvements in pre-existing liver disease. The doctors who conducted this latest study are unsure of the reasons, but think that it could be related to caffeine.
Because of this, researchers in the US wanted to see if it also had an impact on hepatitis C treatment outcomes.
Their research involved 855 people with hepatitis C mono-infection (i.e. they were only infected with hepatitis C). They’d all received a previous course of treatment for the infection, but it hadn’t worked.
Information was obtained from the patients about their daily coffee consumption.
People who drank three or more cups of coffee each day were 80% more likely to have their hepatitis C cured than people who did not drink coffee.
No beneficial effects were associated with tea consumption.
The researchers want further clinical trials to be conducted to confirm if coffee has consistent benefits.
You can find out more about hepatitis C in NAM’s booklet HIV & hepatitis. It is available on our website in English, French, German, Italian, Portuguese, Russian and Spanish.