Strategies for HIV therapy

April 2008    View PDF    En español

Federal recommendations for when to start therapy

ARV treatment should be started in anyone with a history of an AIDS-defining illness or before CD4 count falls below 350.

ARV treatment is recommended regardless of CD4 count for:

• Pregnant women
• People with HIV Associated Nephropathy (HIVAN)
• People co-infected with Hepatitis B Virus (HBV) for whom treatment of HBV is warranted

The risk of death or serious illness in people with CD4 counts above 350 is low, so any benefit from starting treatment at high CD4 counts is likely to be small.

There are data — for example the ATHENA cohort — that show that people who start HIV treatment with CD4 counts above 350 are more likely to achieve and maintain CD4 counts above 800.

Similarly, in the Johns Hopkins Cohort people who started treatment with CD4s below 350 were less likely to achieve and maintain CD4 counts above 500.

Early HIV treatment has the potential to reduce HIV transmission rates.

Factors weighing against early treatment would be:

• the necessity of life-long treatment,
• the lack of long-term data on most HIV drugs,
• the potential for developing drug resistance, and
• the interference with quality of life.