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IRIS on HAART Initiation
Aug 8, 2008

Hello,

My 32 year old uncle has been initiated on HAART and treatment for PCP. His CD4 Cell Count was 18. I came across some information from an acquintance about the possibility of Immune Reconsititution Syndrome for persons who start treatment on such low CD4s. Is there anything we can do to prevent this or at least mitigate it should it occur. Further at what stage would you recommend initiation on ART? I am also HIV+ but at a CD4 of between 500- 600 my doctor has advised that we hold off initiation on HAART.

Please advice and thank you for your help.

Response from Dr. Henry

There is no treatment proven to safely prevent IRIS when starting ART other than perhaps pre-treatment for weeks/months of any known AIDS-related opportunistic infections (such as TB or other mycobacterial diseases). When to start HAART is an individual decision based on symptoms, rate of CD4 decline, RNA level and trends, existence of other conditions (such as cardiovascular disease, pregnancy, renal disease, or hepatitis B). Current guidelines in US recommend starting when CD4 count < 350. Studies looking at higher thresholds for starting HAART are planned since there is some modest evidence from uncontrolled studies of an advantage of starting HAART when CD4 count < 500(such as the START trial looking at starting at CD4 count > 500 versus < 350). KH



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