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[e-drug] Starting ART at a CD4 of 350 rather than 200?

E-DRUG: Starting ART at a CD4 of 350 rather than 200?
[This recommendation from Sydney will have consequences for the number of
HIV/AIDS patients that need to be treated! Copied with thanks from
www.aidsmap.com  WB]

Report from the IAS meeting in Sydney:

HIV treatment guidelines currently recommend that starting HIV treatment
should be delayed until a person's CD4 cell count has fallen to around 200
cells/mm3, or the development of HIV-related symptoms if this is sooner.
Most other HIV treatment guidelines have similar recommendations.

But doctors at the Sydney conference argued that HIV treatment should be
started significantly earlier. Indeed, one leading doctor said the question
should be when not to treat HIV rather than when to treat.

Researchers told the conference that there was accumulating and persuasive
evidence supporting the earlier initiation of anti-HIV treatment. Firstly,
it has been recognised that soon after initial infection with HIV, the virus 
causes significant and sustained damage to lymphoid tissue in the gut.

Second, there is now good evidence that patients who started HIV therapy
with a CD4 cell count of 350 cells/mm3 are much more likely than those who
delayed starting treatment until their CD4 cell count was in the 200
cells/mm3 range to experience a long-term strengthening of their immune
systems to near-normal levels. 

Thirdly, there is accumulating data showing that a low CD4 cell count
increases an HIV-positive individual's risk of developing serious
non-AIDS-defining illnesses, such as cancer, heart-disease, liver problems
and kidney failure. Prof Jim Neaton highlighted results from the SMART
treatment interruption study showing that patients who interrupted their
therapy when their CD4 cell count was 350 cells/mm3 were significantly more
likely than those who took their HIV drugs continually to develop serious
non-AIDS-related illnesses. New data from patients in the SMART study shows
that there were important differences in markers of immune activation
between people in the continuous treatment and treatment interruption arms. 

Fourthly, the Sydney conference was told that starting treatment at 350
cells/mm3 rather than the currently recommended 200 cells/mm3 could
significantly reduce new HIV infections because fewer people would have
infectiously high HIV viral loads.

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