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Study Finds More Health Benefits From Starting HIV Treatment Very Early, within 6 months of infection
  " For the study, investigators recruited men who had been infected with HIV for less than six months, men who had the disease for more than six months and a third group that was disease free. They then started infected men on ART. After one year of follow up, researchers found that men who began therapy sooner had stronger immune cells that were more capable of producing antibodies for the virus. Additionally, men in the late-treatment group had higher levels of "exhausted" immune cells, which had shut down and were no longer fighting the infection.
BETHESDA, Md -- September 28, 2010 -- Patients with HIV who begin antiretroviral therapy (ART) soon after acquiring the virus may have stronger immune responses to other pathogens than patients who begin ART later, according to a study published in the journal Blood.
This finding suggests that early initiation of ART may prevent irreversible immune system damage and adds to the body of evidence showing significant health benefits from early ART.
Scientists from the National Institute of Allergy and Infectious Diseases (NAID), part of National Institutes of Health, Bethesda, Maryland, measured the quantity and qualities of B cells in blood samples taken from 3 groups of study volunteers: men who had been HIV-positive for fewer than 6 months; men who had been HIV-positive for 6 months or more (often for several years); and men who did not have HIV. The HIV-positive men began taking ART for the first time once they entered the study.
At the outset of the study, the number of B cells in the blood of both groups of HIV-positive men was significantly lower than the number of B cells in the blood of the uninfected men. Once the 2 groups of HIV-positive men began ART, however, the numbers of B cells in their blood increased significantly and to similar degrees.
Qualitatively, however, the compositions of B cells in the 2 groups of HIV-positive men differed notably throughout the study.
The researchers compared the relative proportions of 6 different types of B cells within and among each of the 3 groups at the study outset and 1 year after the HIV-positive men had started ART. They observed that early treatment restored resting memory B cells to the same level as that in HIV-negative men, but late treatment did not. Resting memory B cells remember how to make antibodies to a pathogen and can last a lifetime. Also, early ART reduced the proportion of immature B cells to the same level as that in HIV-negative men, but late treatment did not.
In addition, after 1 year, the late-treatment group had a significantly greater proportion of so-called exhausted B cells -- those that have shut themselves off and resist doing their usual pathogen-fighting activities -- compared with the other 2 groups of participants.
To learn how these differences affected immune system responses to new infections, the research team examined how the 2 groups of HIV-positive men responded to influenza vaccination at the start of the study and 1 year after beginning treatment. At the 1-year point, a significantly greater proportion of B cells made anti-influenza antibodies in the early treatment group compared with the late treatment group. This suggests that starting ART early in the course of HIV infection enables individuals to fight off other pathogens better than if they start ART later, when the infection has become chronic.
SOURCE: National Institutes of Health
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