Waiting to Start ART in These Patients? Think Again.

Clinicians might be tempted to hold off on starting antiretroviral therapy (ART) in certain patients, such as those who have recently seroconverted and those with very slow CD4-cell declines. However, new research suggests that both these groups could benefit from more immediate ART.

Mussini and colleagues studied pre- and post-ART CD4-cell trajectories in more than 2000 HIV-infected patients in the CASCADE cohort. They found that the patients with the slowest CD4-cell declines in the 2 years before ART initiation (<61 cells/mm³/year) also had the slowest immunologic responses to ART. During the first year of treatment, the mean rate of CD4 recovery among these patients was 9.5 cells/mm³/month, compared with 13.9 cells/mm³/month among the ot…