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Starting Antiretroviral Therapy at CD4+ Counts Above 500 Improves Survival, Study Suggests
Initiating antiretroviral therapy before CD4+ counts fall to 500 may improve survival in patients with HIV, reports the New England Journal of Medicine online.
The study involved two groups comprising 17,500 asymptomatic HIV-infected individuals. In the first group, patients who deferred treatment until CD4+ counts fell below 351–500 cells/cubic millimeter had a 69% increased risk for death, relative to those who began treatment with counts in that range. In the second group, similarly, those who delayed treatment until CD4+ counts fell to 500 or lower had a 94% increase in mortality, relative to those who began treatment earlier.
In an accompanying NEJM editorial, Drs. Paul Sax (who serves as editor-in-chief of Journal Watch HIV/AIDS) and Lindsey Baden say that 5 years ago, physicians "could have made an excellent case" to delay treatment for asymptomatic patients with CD4+ counts above 500, but now, they conclude, "we should be ready and willing" to begin therapy for such patients who are eager to start.
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NEJM article (Free)
NEJM editorial (Subscription required)
Published in Physician's First Watch April 2, 2009
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