Antiretroviral Therapy Can Be Delayed in Individuals With Higher CD4+ T Cell Counts, Two Studies Say

Triple combination antiretroviral therapy can be "safely" delayed in patients with CD4+ T cell counts higher than 200 cells per milliliter, according to two studies presented yesterday at the XIV International AIDS Conference in Barcelona, Spain, the Washington Post reports. Alvaro Munoz of Johns Hopkins University's Bloomberg School of Public Health examined HIV-positive people who started antiretroviral therapy when their CD4+ T cell counts were below 200, between 201 and 350 and between 351 and 500 cells per milliliter. Normal counts are between 600 to 800 cells per milliliter. The study found that while it was "detrimental" to delay treatment until after CD4+ T cell counts dropped below 200 cells per milliliter, there was "almost no difference" between people who started treatment with counts between 201 and 350 and between 351 and 500. The federal government currently recommends that HIV-positive people start antiretroviral treatment when CD4+ T cell counts drop below 350 cells per milliliter. A study presented by Genevieve Chene of Bordeaux, France, found a "similar outcome." The Post reports that the findings "could be vital in the campaign to bring treatment" to HIV-positive people in developing countries who often cannot afford the cost of long-term antiretroviral therapy (Brown, Washington Post, 7/10).

Additional Research
In a separate study released yesterday at the conference, drug maker Roche Holding AG announced "encouraging results" of four studies that examined "double boosting" -- an experimental therapy that "combines a standard dose of AIDS drug with very low doses of additional medicine." The trials involved combining Roche's protease inhibitor treatment saquinavir with a "low" dose of Abbott Laboratories Inc.'s drug Kaletra, a mixture of lopinavir and ritonavir. While Kaletra has "no therapeutic benefit" itself, it prevents the body from breaking down saquinavir. Cal Cohen, director of research at Community Research Initiative of New England, said that double-boosting is a "promising treatment strategy for even the most difficult-to-treat HIV patients" (Reuters Health, 7/9).

New Treatment Guidelines for Developing Nations
The World Health Organization and the International AIDS Society yesterday officially released new guidelines that simplify the administration of HIV therapies and "give options to poor regions lacking medical staff or sophisticated laboratories," Reuters Health reports. The guidelines are expected to "reduc[e] the complexity" of antiretroviral treatments and provide developing countries with "simple advice on options for treating" HIV infection. WHO Director-General Gro Harlem Brundtland said, "For the first time we now have the chance to apply a simplified, easy-to-follow public health approach to AIDS treatment rather than complex individual treatment regimens" (Reuters Health, 7/9).