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University of Minnesota researchers find better time to start HIV therapy

Courtesy: NIAID

Patients suffering from an AIDS-related infection should start therapy later than expected, according to a new study from the University of Minnesota Medical School.

In a report set to appear in the June 26, 2014, issue of the New England Journal of Medicine, researchers found that waiting 4-6 weeks to start HIV therapy after cryptococcal meningitis diagnosis resulted in 15% better survival than starting HIV therapy 1-2 weeks after diagnosis.

“The overall result is quite surprising. As with every other AIDS-related infection, starting HIV therapy sooner is better,” said the study’s lead author David Boulware, M.D., M.P.H. “It appears that brain infections are different.”

Cryptococcal meningitis is a deadly fungal infection in and around the brain that is the second most common AIDS-defining illness. The fungus lives in the environment, and people are exposed by inhaling the fungus. Persons with weakened immune systems can develop a severe, life threatening infection.

An estimated 350,000 cases of cryptococcal meningitis occur worldwide each year. In the United States, about 20% of people with the condition die during their initial hospitalization. The rate of death in Africa nears 50%.

Due to this high rate of death, researchers investigated whether 6-month survival could be improved by starting HIV therapy earlier while patients were still hospitalized instead of waiting to start HIV therapy in an outpatient clinic setting 4-6 weeks after diagnosis. The research study involved 177 participants, half of whom received earlier HIV therapy at 1-2 weeks and half received deferred HIV therapy at 4-6 weeks after their meningitis diagnosis. The participants were followed for one year receiving standard international treatment of their meningitis and HIV.

The study was conducted in two hospitals in Uganda and Cape Town, South Africa, by researchers from the University of Minnesota in collaboration with Makerere and Mbarara Universities in Uganda and the University of Cape Town in South Africa. The study was funded by a $6.3 million grant from the U.S. National Institutes of Health. Grant numbers: NIAID, U01AI089244, K23AI073192, T32AI055433, K24AI096925, 081667, 098316, 087540.

“This has influenced U.S. and international treatment guidelines for HIV-related cryptococcal meningitis,” Boulware said. “Overall this is the most common cause of meningitis in adults in Africa and the second most common AIDS-related infection in Africa after tuberculosis.”

The project has allowed 30 University of Minnesota students and trainees to gain experience in global health and international research. The Minnesota trainees’ experiences in Africa have helped them gain substantial clinical expertise in how to manage the complications of HIV/AIDS. Although AIDS-related infections are less common in Minnesota, 35% of new HIV diagnoses in Minnesota still occur at time of AIDS when persons are having problems with AIDS-related infections.