AIDS: Delaying Treatment Has Health and Financial Costs
25 November 2010
A new study says delaying treatment for people infected with HIV can have long-term health and financial consequences. The findings add to the debate over when anti-retroviral treatment should begin.
A growing body of research says starting HIV-infected people on drug treatment sooner is better for the patient. Initially, the drugs were given when a person’s CD4 immune cell count fell to 200 or below. By that time, the patent could have full-blown AIDS.
Now the general recommendation is to start treatment when CD4 counts reach 350 – before the immune system collapses. Despite that recommendation, many people are receiving delayed treatment.
Looking at the evidence
Dr. Kelly Gebo – a Johns Hopkins University professor of Epidemiology – is the senior author of the study. Gebo and her team reviewed the medical records of more than 8,000 patients in the United States between 2000 and 2007.
“So, we actually didn’t look at when to start treatment. We looked at when people presented for care. And we found that unfortunately nearly half of people – 43 percent of people – were presenting late for care. And those people cost more over the long run,” she says.
Gebo says the study did not look at why treatment was delayed, but the findings did give a few hints.
“One of the things anecdotally that we do tend to find,” she says, “is that people are hospitalized for a severe opportunistic illness and then sort of follow-up for outpatient care. They may have known they were HIV infected for a long period of time and not come for care just because they didn’t feel bad or everything was going well. And then when something catastrophic happens is when they start embarking on care.”
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