New HIV Advice: Start Treatment Sooner

HIV treatment guidelines advises starting antiretrovirals earlier

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) If you've just been diagnosed with HIV, would you want to wait to start treatment until the virus begins to affect your body? That's been the standard procedure for years.

But that's changing now, when a panel of experts announced their recommendation at this year's International AIDS Conference in Washington DC.

A new guideline for treatment advises that new HIV patients start treatment immediately, rather than waiting for their CD4 cell count to drop below 500.

"Request antiretroviral treatment as soon as you've been diagnosed with HIV."

The new recommendation comes from International Antiviral Society-USA, formerly known as AIDS Society-USA, a nonprofit group that focuses on physician education. Melanie A. Thompson, MD, of the AIDS Research Consortium of Atlanta presented the report at the conference.

The recommendations were also presented in an article in the journal JAMA.

Antiretroviral therapy – the use of HIV-fighting drugs – revolutionized the treatment and prognosis for people with HIV in the mid 1990s. Patients typically take a combination of three drugs to suppress the virus in their bodies.

Since its introduction, advancements in antiretroviral therapy (ART) have “dramatically reduced numbers of opportunistic diseases and deaths where ART is accessible,” according to the article. Fewer people die from AIDS, and many HIV-infected individuals live long and productive lives.

Traditionally, a patient diagnosed with HIV starts ART when their CD4 cells – a specific kind of immune cell – drops below 500 cells per cubic millimeter of blood. The CD4 count is important because it helps doctors measure the stage of infection.

A normal CD4 count is from 500 – 1,500. When it drops below 500, it means that HIV is destroying these helpful white blood cells.

Recent studies have questioned the approach of holding off on treatment. One trial that experimented with initiating a drug regimen after infection found that patients had a lower risk of developing AIDS-associated diseases like tuberculosis and bacterial infections.

Another study found that patients who started ART when their CD4 count hit 350 had a 38 percent increased risk of developing AIDS and dying, than those who started ART early.

In the background information of the new guidelines, the panel wrote that this new information warranted an update to the previous guideline.

The report announced: “New recommendations for HIV patient care include offering ART to all patients regardless of CD4 cell count, changes in therapeutic options, and modifications in the timing and choice of ART in the setting of opportunistic illnesses such as cryptococcal disease and tuberculosis.”

Reviewed by: 
Review Date: 
July 22, 2012
Last Updated:
February 11, 2013