HIV Wellness Bytes

When to Start Treatment
New guidelines recently issued by the U.S. Department of Health and Human Services indicate that initial treatment be considered for patients with CD4 cell counts less than 350 or plasma HIV-1 RNA greater than 30,000 (by bDNA assay) or 55,000 (by RT-PCR assay) copies/ml. Individuals with CD4 counts greater than and viral loads less than the above values may be able to safely defer starting medication. Symptomatic patients--no matter what their CD4 and viral load counts--are advised to start medication.

Guidelines Have Been Revised
The new guidelines have been revised for many reasons: The discovery and understanding of viral reservoirs have diminished the rationale and enthusiasm for early treatment. The consensus today is that by using the currently available medications, it's impossible to completely eradicate the virus. However, present HAART (highly active anti-retroviral therapy) may prevent viral resistance and permit long-term control. Toxic side effects may preclude a person's ability to tolerate these medications over the long term. It's almost impossible for an individual to properly adhere to the drug-taking regimen in order to prevent resistance from forming. Also recent studies have shown that individuals who defer therapy until their CD4 counts fall to 200-350 do as well as those who start therapy earlier.

Patients who CD4 counts fall below 200 should start therapy, but it has yet to be determined what the exact count should be at initiation.