Study uncovers new ground about when to start HIV therapy
A major question that has recurred since the availability of potent combination anti-HIV therapy (commonly called ART or HAART) is when this therapy should be initiated to ensure the optimal health of HIV-positive people. New research has revealed that early therapy may be highly beneficial.
About starting ART
Over the past 15 years, leading treatment guidelines have increased the immunological threshold at which treatment should be started in adults—from 200 cells/mm3 to 350 cells/mm3 to 500 cells/mm3, and now many guidelines recommend offering treatment soon after diagnosis regardless of CD4+ count (immediate therapy).
The recommendation to offer earlier therapy is based on a large body of research on both the health and prevention benefits of ART. Furthermore, initiating ART when there is less immunological damage generally enables better preservation and enhancement of the immune system. What is more, starting ART when the immune system is not greatly weakened ensures that treatment is generally well tolerated.
Clinical trials and observational studies have shown that keeping CD4+ counts at 500 cells/mm3 or higher with ART significantly reduces the chances of developing AIDS-related complications and other unfortunate events.
Emerging research suggests that starting ART at the threshold of 500 cells/mm3 may, in some cases, be insufficient for normalizing the functioning of the immune system. A new study has shown that starting ART within 12 months of becoming HIV positive results in measureable and significant immunological benefits. This study also provides insight into the normal range for CD4+ cells that has implications for therapeutic goals in HIV treatment.