Comments on: Will NIH Urge New HIV Guidelines Boosting Meds? http://www.pharmalot.com/2008/10/will-nih-urge-new-hiv-guidelines-that-boost-meds/ News, Comment and Conversation Mon, 22 Mar 2010 04:12:28 +0000 http://wordpress.org/?v=2.6.2 By: HIV symptoms http://www.pharmalot.com/2008/10/will-nih-urge-new-hiv-guidelines-that-boost-meds/#comment-407050 HIV symptoms Sun, 24 May 2009 07:01:26 +0000 http://www.pharmalot.com/?p=17004#comment-407050 This is very true that HIV positive individual if starts taking medicine as soon as he is dignosed can live his life , to better extent This is very true that HIV positive individual if starts taking medicine as soon as he is dignosed can live his life , to better extent

]]> By: Joseph Sonnabend http://www.pharmalot.com/2008/10/will-nih-urge-new-hiv-guidelines-that-boost-meds/#comment-379598 Joseph Sonnabend Wed, 29 Oct 2008 14:08:39 +0000 http://www.pharmalot.com/?p=17004#comment-379598 Merely reporting expert recommendations on the basis of a report of a study that includes few details, may have the effect of persuading patients and their doctors to start anti HIV treatment as early as at a CD4 count of 500. An immediate question for example, which may indeed be answered in the full account of the study, is how many of those with a CD4 count below 350 had counts under say, 100, 50 or even 10. We would not find it surprising that mortality was higher amongst these patients. To best serve our HIV infected patients we do need to know when to start treating them from evidence derived from prospective studies not on retrospective reviews of records, which can only generate hypotheses. HIV disease is characterized by an enormous variability in individual rates of disease progression. Therefore recommendations about when to start should take individual rates of progression into account. There have been numerous revisions of guidelines, from the NIH or the International AIDS Society, and these will continue to change. A firm general answer on whether, on average, it's better to start treatment early or to defer it could have been answered by now had we done the appropriate clinical trials. One cannot help but note that HIV treatment recommendations are associated with an increase in the amount of drugs prescribed. By discouraging further studies on treatment interruptions, by recommending that these interruptions not be done, and by recommending early treatment. drug sales are increased. It is not difficult to find information on the financial ties to industry of many who make these recommendations, as well as industry support for so called educational entities that ceaselessly disseminate these views. Starting treatment early, and avoiding treatment interruptions may in fact turn out to be in the patients best interests. But the studies to provide firm information on this have yet to be done. Merely reporting expert recommendations on the basis of a report of a study that includes few details, may have the effect of persuading patients and their doctors to start anti HIV treatment as early as at a CD4 count of 500. An immediate question for example, which may indeed be answered in the full account of the study, is how many of those with a CD4 count below 350 had counts under say, 100, 50 or even 10. We would not find it surprising that mortality was higher amongst these patients.

To best serve our HIV infected patients we do need to know when to start treating them from evidence derived from prospective studies not on retrospective reviews of records, which can only generate hypotheses. HIV disease is characterized by an enormous variability in individual rates of disease progression. Therefore recommendations about when to start should take individual rates of progression into account.
There have been numerous revisions of guidelines, from the NIH or the International AIDS Society, and these will continue to change. A firm general answer on whether, on average, it’s better to start treatment early or to defer it could have been answered by now had we done the appropriate clinical trials.

One cannot help but note that HIV treatment recommendations are associated with an increase in the amount of drugs prescribed. By discouraging further studies on treatment interruptions, by recommending that these interruptions not be done, and by recommending early treatment. drug sales are increased. It is not difficult to find information on the financial ties to industry of many who make these recommendations, as well as industry support for so called educational entities that ceaselessly disseminate these views.

Starting treatment early, and avoiding treatment interruptions may in fact turn out to be in the patients best interests. But the studies to provide firm information on this have yet to be done.

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