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Minimum Threshold Suggested for HIV Antiretroviral Therapy

Analysis of 18 studies shows benefit of starting therapy when CD4 counts are 350 or below

THURSDAY, April 9 (HealthDay News) -- In AIDS-free HIV-infected patients, a CD4 cell count of 350 should be the minimum threshold for initiation of antiretroviral therapy, according to a study published online April 9 in The Lancet.

Jonathan Sterne, Ph.D., of the University of Bristol, U.K., and colleagues from the When To Start Consortium analyzed data from 18 cohort studies of 21,247 patients who were followed up before the introduction of combination therapy and 24,444 patients who were followed up from the start of treatment.

The researchers found that the rates of AIDS and death were higher in patients starting combination therapy with a CD4 cell count of 251 to 350 than in those starting therapy with CD4 cell counts of 351 to 450 (hazard ratio, 1.28). They also found the rates of overall mortality were higher in patients with CD4 cell counts of 251 to 350 who deferred treatment (hazard ratio, 1.13).

"Thus, our findings should help to guide physicians and patients in deciding when to start antiretroviral treatment," the authors write. "The evolution of guidelines has been compared to the swings of a pendulum, from initial enthusiasm for early treatment, through to caution because of concern about toxic effects and the risk of resistance and loss of treatment options, to more recent calls for earlier treatment."

A variety of pharmaceutical industry financial disclosures were made by the authors.

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