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smart study
Jun 2, 2002

I really am interseting in getting into the smart study.Hoping to be put in the wait(no drugs) arm.The only thing that scares me is the cd4 cut off is 250.Being someone who always has 1000 this to me seems risky,however I would LOVE nothing more than to be off meds.I know my doctor is going to say this number is too low.I wish there were a study that had a higher cutoff.What's your opinion?P.S.- gerally great health,chronic infection,just cometic side effects and lipids.Hav been on medication 6 years.

Response from Dr. Henry

The risk for any AIDS-related events is extremely low if the CD4 count > 250 (the starting time for therapy in the drug conservation arm of the SMART study). 50% of persons in the SMART trial get randomized to the continuous therapy arm and 50% into the drug conservation arm (= stop drugs until CD4 count reaches 250). In many European countries the initial level of CD4 count whereby treatment is recommended is in the 200-250 range. We don't know the best way to use potent antiretroviral therapy for the long haul (> 5-10 years) when you balance viral suppression early versus toxicity and resistance issues. If your CD4 count was never too low (< 200) and viral load never too high (>>100,000) then stopping meds is safer than if the CD4 count had been low . KH



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