Late Treatment Start Can Lead to Faster HIV Progression

Starting highly active antiretroviral therapy with a CD4-cell count below 200 can result in faster HIV disease progression, Vanderbilt University researchers reported in the December 1 edition of Journal of Infectious Diseases. The records of nearly 1,200 HIV-positive patients were analyzed for appearance of opportunistic infection or death after the initiation of HAART. Patients with baseline CD4 counts below 200 had faster disease progression, were less likely to suppress HIV to undetectable levels, and were more likely to develop an opportunistic infection or die than those with baseline counts above 201. There were no statistical differences in disease progression between individuals who started HAART with between 201 and 350 CD4 cells and those with more than 350 cells. 'Our study helps to clarify when HAART should be initiated in asymptomatic patients,' the researchers concluded. 'It is clear that disease progression is slower when therapy is initiated at CD4 lymphocyte counts of greater than 200 cells per microliter.'