When to Start ART: Yet Another Take

Data from the CASCADE study support starting antiretroviral therapy before the CD4 count drops below 350 cells/mm³ — but not before it drops below 500 cells/mm³.

Definitive answers on when to start antiretroviral therapy (ART) in asymptomatic HIV-infected patients will require a randomized clinical trial, such as START, which is currently under way. In the meantime, however, we must base our clinical decisions on the results of observational studies. Several such studies have already been published (NA-ACCORD, ART-CC, and HIV-CAUSAL), but the duration of HIV infection could not be assessed accurately in any of them. Enter the CASCADE study, which is restricted to patients with a defined date of HIV acquisition.

For this retrospective analysis, investigators used long-term follow-up data from approximately 9500 HIV-infected patients to construct a series of nested subcohorts, one for each month from J…

Reviewing Author

Paul E. Sax, MD

Disclosures

Consultant/Advisory BoardGilead Sciences; GlaxoSmithKline/ViiV; Merck; Shionogi

Grant/Research SupportNIH; Gilead Sciences; ViiV

Editorial BoardsUpToDate; Clinical Infectious Diseases

Paul E. Sax, MD

Disclosures

Consultant/Advisory BoardGilead Sciences; GlaxoSmithKline/ViiV; Merck; Shionogi

Grant/Research SupportNIH; Gilead Sciences; ViiV

Editorial BoardsUpToDate; Clinical Infectious Diseases

When to Start ART: Yet Another Take

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Reviewing Author