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New standard for starting HAART?
Jan 28, 2005

I have consistently read in this Forum that the standard for starting HAART is with CD4 count somewhere between 200 and 350. I have also generally heard that viral load is not much of an indicator of when to start HAART, especially compared to CD4 count. I recently heard that new thinking is that HAART should be started when CD4 falls below 500. What are your thoughts on this? I'd obviously like to delay starting meds as long as possible, but certainly not at the cost of doing permanent damage to my immune system. Also, is there some level at which viral load needs to be factored into the decision, even when CD4 count is high? Thanks, as always, for your sage and reassuring advice!

Response from Dr. Pierone

The formal guidelines have not changed at this point and probably won't for some time. Of course the guidelines are written mainly by older white male academic physicians that don't actually treat very many HIV-infected patients (because they are busy doing research and writing guidelines).

But the new thinking by some early adopter type HIV thought leaders is to consider starting antiretroviral therapy sooner. It was the cumulative toxicity of first generation antiretroviral cocktails that spearheaded the shift towards deferred treatment. So it is logical that one of the drivers back towards early treatment is the emerging consensus that newer antiretroviral regimens are safer and easier to take. But I don't think that delaying therapy will lead to permanent damage to the immune system.

The viral load is important in a general sense in that a higher viral load would shift the balance towards early treatment. There is a rough correlation with average viral load and rate of CD4 count decline, so it does deserve consideration.

Thanks for posting and stay tuned.

Early versus Late treatment
2 doctors 2 opinions on proper therapy

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