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Antiretroviral Therapy Should Start Before CD4+ Counts Hit 350, Researchers Say

A CD4+ count of 350 cells/microliter "should be the minimum threshold at which antiretroviral therapy is started" in patients with HIV, researchers conclude online in Lancet.

The researchers examined data on more than 45,000 HIV-infected patients who were followed in cohort studies in North America and Europe. They found that deferring antiretroviral treatment until CD4+ counts fell to 251–350, rather than beginning therapy at counts of 351–450, was associated with significantly increased risk for progression to AIDS or death (hazard ratio, 1.28).

Commentators say these results are "not definitive," noting, for example, the lack of data on serious treatment complications that could offset the benefits (e.g., cardiovascular and renal disease).

(Last week, Physician's First Watch reported on a study suggesting that beginning treatment while CD4+ counts are above 500 improves survival.)

LINK(S):

Lancet article (Free abstract; full text requires subscription)

Lancet comment (Subscription required)

Physician's First Watch coverage of recent study suggesting benefits of therapy before CD4+ counts hit 500 (Free)

Published in Physician's First Watch April 9, 2009