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starting earlier if older

Apr 15, 2008

I was surprised with your answer to the HIV pos 64 yo. You said "As the CD4 recovers more slowly in older (>40 years) people due to the involution (retirement) of the T-cell producing thymus gland it makes sense to start HIV treatment when your CD4 cell count is a bit higher, say more around 350-400"

I am 59 and waited for three years till my CD4 count dipped below 350 (two months ago and started meds)which I was told is based on the new 2008 recomendations. If I had followed your recommendation I should actually have started two years earlier. My provider never indicated that the CD4 starting point is different for those of us over forty. Is this in the recent revised recommendations?

Response from Dr. Moyle

No this is not in current guidelines but CD4 recovery linked to age is certainly a well documented phenomenon. Unfortunately, as guidelines tend to be most influenced by randomised trials and most trials don't get a lot of older (+50yrs) folks into them, nor typically analyse by age at entry, there are no specific guidelines on treating older patients. So my answer reflects my own read of the data. It sounds like you started around 350, in close keeping with what I suggested. Kind regards Graeme

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