New Guidelines for Starting Treatment?
May 23, 2006
In a recent article in HIV Plus Magazine there was a brief article regarding possible changes in the theories on when it is best to begin treating HIV. My CD4 counts are in the 700-800 range and viral load is usually in the 7,000 - 10,000 range so I am not on any therapy (I was diagnosed less than one year ago). My doctor suggested waiting until my CD4 dropped below 250 to start considering starting therapy. The article suggested that studies have shown that those who start therapy with a CD4 count above 350 have a far better chance of keeping and AIDS diagnosis at bay. Here is a selection from the article:
"After a median of three years observation, the risk of either progression to AIDS or death was almost three times greater in the patients who began treatment with CD4 counts of less than 200 compared to the group in the 201350 range. Those who had CD4 counts above 350 had a 26% less chance of progression to AIDS or death when compared to the mid-range group."
The full article can be found here: http://www.hivplusmag.com/column.asp?id=937&categoryid=4
What does this mean to someone like me? Is it better to approach treatment in the hit hard, hit early model or just wait and see and possibly lower my chances for a better outcome.
Response from Dr. Wohl
The data we have available from several studies do support starting HIV therapy at a CD4 that is well above 200. Several studies have shown a benefit when treatment is initiated when the CD4 count is above 350, some others have not. Most all studies agree that starting above 250 is best. I would not wait until your CD4 cell count fell to 250 but would generally tend to recommend therapy at the 350-400 range.
A recent interesting study from a clinic based cohort in the US found that those who wait to start HIV therapy had HIGHER rates of adverse events including kidney and heart problems compared to those commencing HIV treatment.
As therapies for HIV get better tolerated, more convenient and more resistant to resistance, waiting to start them begins to look more and more unwise.
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