Debate has been raging for some time about whether people with HIV should start treatment when their CD4 count drops to 350 or 200. A new study shows better results for patients who get an earlier start.

Patients who start antiretroviral therapy when their CD4 count drops to 350 have significantly stronger immune systems six years later than those who start when their
CD4 count reaches 200.

This is according to a study of 655 patients conducted by Dr Richard Moore of Johns Hopkins University that is due to be published in the 15 February edition of “Clinical Infectious Diseases”.

In South Africa, patients are eligible for ARVs when their CD4 count (which measures the level of immunity in the blood) drops to 200.

Researchers found that, in all patients, increases in CD4 counts levelled off after four years of ARV treatment.

After six years of treatment, those who had started with CD4 counts of between 201 and 349 now had an average CD4 count of 508. But those who started ARVs with a CD4 count above 350 had an average CD4 count of 829 – which is considered to be normal.

All three groups of patients had significant increases in their CD4 counts for the first four years of ARVs, after which they reached “a plateau”, according to the study.

The choice of anti-HIV medication did not affect significantly affect CD4 cell gains, neither did race or gender (most were black men).

Anso Thom


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