Timing of ART Initiation — Still No Definitive Answers

Data from two observational studies presented at CROI 2009 are informative but not conclusive. However, both studies point to starting therapy at least before the CD4 count falls below 350 cells/mm³.

Recommendations about when to initiate antiretroviral therapy (ART) continue to evolve, with the trend moving toward starting at higher CD4-cell counts. Two studies reported at this year’s Retrovirus Conference are instructive regarding this trend.

Building on a previous analysis that demonstrated a survival benefit to starting ART at CD4 counts >350 cells/mm³ (JW AIDS Clin Care Nov 10 2008), Mari Kitahata and colleagues from the NA-ACCORD study have now assessed the value of starting ART at CD4 counts >500 cells/mm³ [Abstract 71]. Their analysis involved 9155 HIV-infected people who were treatment naive and had CD4 counts >500 cells/mm³ when they enrolled in observational cohorts in North America between 1996 and 2006. During follow-up, the…

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Charles B. Hicks, MD

Disclosures

Consultant / Advisory boardGilead Sciences; ViiV; Merck

RoyaltiesUpToDate, Inc.

Grant / Research supportNIH; Department of Health and Human Services

Charles B. Hicks, MD

Disclosures

Consultant / Advisory boardGilead Sciences; ViiV; Merck

RoyaltiesUpToDate, Inc.

Grant / Research supportNIH; Department of Health and Human Services

Timing of ART Initiation — Still No Definitive Answers

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