Antiviral Guidelines Might Be Low

Researchers at Johns Hopkins University and the New York Academy of Medicine report in the September 15 edition of The Journal of Infectious Diseases that current guidelines that suggest beginning highly active antiretroviral therapy when CD4 counts drop below 350 may be too low and that earlier therapy may be more beneficial. A study of 583 HIV-positive and 920 HIV-negative injection-drug users showed that survival rates for those infected matched those of their HIV-negative peers only if HAART was started when CD4-cell counts were above 350. Mortality was higher for those with fewer than 350 cells who were not on HAART and for subjects who initiated therapy with counts between 200 and 350. 'Assuming that the goal of HAART is to produce outcomes similar to those seen in HIV-seronegative people, our results provide information that suggests that HAART should be initiated or switched to at higher CD4-cell levels than currently recommended,' the researchers conclude.