AIDS and Death Despite High CD4-Cell Counts

When should antiretroviral therapy (ART) be started in HIV-infected patients? Current treatment guidelines suggest that ART be considered when the CD4 count falls below 350 cells/mm³ or the viral load exceeds 100,000 copies/mL. Now that treatments have become less toxic, many clinicians are thinking of starting therapy in patients with higher CD4-cell counts. To examine this issue, researchers analyzed the risk for AIDS events and death in treatment-naive HIV-infected patients seen in any of 10 U.K. clinics (17,609 patients; 30,313 person-years of follow-up).

Among patients with CD4 counts >350 cells/mm³, rates of severe AIDS-related events or death were 0.79-fold lower per 100 cells/mm³ higher CD4 count (P<0.001). Significant differences we…