Adding to the Confusion

While recommendations for beginning antiretroviral therapy have been all over the board since the arrival of protease inhibitors in the late 1990s, most HIV experts seem to have settled on a 350 CD4-cell count threshold as the starting point. But a new study in the Journal of Acquired Immune Deficiency Syndromes suggests HIVers may do better and live longer if the drugs are started even earlier. Spanish researchers analyzed data from more than 2,000 previously treatment-naive HIVers who began treatment after January 1998. They discovered that HIVers who deferred treatment until their CD4-cell counts fell below 200 had the highest risk of disease progression, an eventual AIDS diagnosis, and death. Those who began anti-HIV drugs when their CD4-cell counts were above 350 had the best outcomes. The data suggests 'the best time to start HAART is before the CD4 count falls to lower than 350,' the researchers say.