When to Start ART in Asymptomatic Patients

Data continued to accumulate in 2011 to support starting antiretroviral therapy before CD4 counts drop below 350 cells/mm³ and perhaps even earlier.

New data addressing the question of when to start antiretroviral therapy (ART) were published in 2011, although none of the studies definitively determined the CD4-cell “sweet spot” for starting therapy in asymptomatic patients.

Previous studies have suggested a benefit to starting ART at CD4 counts between 350 and 500 cells/mm³ or even, in the case of the NA-ACCORD study, at CD4 counts above 500 cells/mm³ (JW AIDS Clin Care Apr 17 2009). This year, the CASCADE study provided further support for starting ART before CD4 counts drop below 350 cells/mm³ but showed no benefit to starting above 500 cells/mm³ (JW AIDS Clin Care Oct 7 2011). As might be expected, the benefits of ART were most profound for patients with the lowest baseline CD4-cell …

Author

Sonia Nagy Chimienti, MD

Disclosures

Nothing to disclose

Sonia Nagy Chimienti, MD

Disclosures

Nothing to disclose

When to Start ART in Asymptomatic Patients

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