Delaying HIV Treatment.
The treatment guidelines from the Department of Health and Human Services aim to balance the long-term adverse effects of antiretroviral therapy against the benefits of early viral control. The guidelines advise patients to delay antiretroviral therapy until CD4 counts fall below 350 cells/ mL.
The findings of a study of more than 1,000 patients indicate that CD4 counts may need to dip below 201 cells /[micro]L before highly active antiretroviral therapy (HAART) significantly reduces disease progression.
Dr. Timothy Sterling of Johns Hopkins University, Baltimore, reported at a conference on retroviruses and opportunistic infections that HAART slowed disease progression among patients with baseline CD4 counts of 200 cells/ [micro]L or less, compared with similar patients who did not receive HAART.
But among patients with baseline CD4 counts of 201-350 cells/[micro]L, HAART was not associated with a decreased risk in disease progression.
HAART similarly did not appear to make much of a dent in progression among patients with baseline CD4 counts greater than 350 cells/[micro]L.
The guidelines advise considering treatment in these patients if the plasma viral load of HIV RNA rises to 30,000 copies/mL, as measured by the branched DNA test.