Rx Minute: Early HIV Treatment May Improve Survival

Early HIV Treatment May Improve Survival

A new study published in the New England Journal of Medicine suggests that the initiation of antiretroviral therapy earlier in the course of HIV infection may improve survival.

The observational study tracked the survival rates of 17,517 asymptomatic North American patients with HIV, including patients with a CD4+ count ranging from 351 to 500 cells per cubic millimeter and patients with a CD4+ count of more than 500 cells per cubic millimeter. The CD4 cell count is a measure of disease progress which drops as the disease advances. The study results indicate that early initiation of antiretroviral therapy significantly improved survival, as compared with deferred therapy. For patients with a 351-to-500 CD4+ count, the deferral of antiretroviral therapy was associated with an increase in the risk of death of 69%, as compared with the early initiation of therapy. Among patients with a CD4+ count greater than 500, deferred therapy was associated with a 94% increase in the risk of death.

Although further studies are needed, the authors suggest that these results renew the ongoing debate over when to begin treatment for HIV. Current national guidelines advise starting antiretroviral therapy in asymptomatic patients when their CD4+ counts dip below 350.

Bone loss drug may help breast cancer patients

A study recently in the New England Journal of Medicine reports that for some women with breast cancer the addition of zoledronic acid to standard treatments can reduce the risk of disease progression by 36%. Zoledronic acid is a drug normally used to prevent complications such as bone pain or fractures in cancer patients with high blood calcium or bone metastasis.

The study tested the combination of zoledronic acid with two different standard treatments in 1803 premenopausal women with early-stage estrogen-sensitive breast cancer. The trial followed the women for an average of about 4 years.

In addition to the reduced risk of disease progression, the risk of recurrence dropped 35% in the groups taking zoledronic acid. The overall risk of death was not significantly different, but there were 16 deaths in the patients receiving zoledronic acid and 26 among those who did not.

Although zoledronic acid is usually used to prevent complications of cancer and cancer treatments, the authors suggest that the drug may also have direct antitumor effects. Some preclinical tests have suggested that it inhibits tumor cell growth and spread and works synergistically with other treatments.

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