Another Reason to Stay on Your Medication

One of the goals of HIV service providers is to connect patients with care as quickly as possible, especially since early treatment has been shown to provide long-term advantages. But a new French study reports that any immune recovery benefits gained by starting antiretroviral medications may be lost if treatment is later 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 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; but those with HIV typically have ratios below 1.0. 

The study 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:

• Thirty-four percent (244 individuals) started treatment within two months after infection. More than half of those had only one treatment interruption while 47 percent experienced more than one interruption.
• Thirty percent (218 people) did not start taking antiretroviral medications until an average of about two and a half years after infection.
• Thirty-six percent (265 people) started treatment shortly after contracting HIV and remained on ARV treatment continuously.

The study found that those who began ARV treatment quickly and remained on it continuously had an average CD4 count of 731 cells: 125 cells higher than those in the deferred treatment group and 106 cells higher than those who started treatment early only to interrupt it later.

Those who received early care and did not stop taking ARV medications also had higher CD4 to CD8 ratios than those in either of the two other groups. A full 64 percent of the early and continuously treated patients achieved a ratio greater than 1.0, compared with just 40 percent in the deferred group and 36 percent in the treatment interruption group. These results were true even after controlling for things like treatment duration, sex, and age.

AIDSMap reports, “while most people prescribed ART 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.”

The study’s researchers conclude, “Our results underline the critical need in early-treated patients to maintain adherence, in order to limit cumulative HIV viremia [presence of the virus in the blood] and optimize immunological recovery, notably the CD4+/CD8+ ratio.” 

But this does not mean that there is no point in starting treatment early, or in returning to treatment after a gap in adherence. While continuous treatment is better, this study’s findings reiterate that antiretroviral treatment is critical to achiving a healthy immune system when poz.