When is treatment initiated for early symptomatic HIV infection?

Updated: Jan 02, 2019
  • Author: Robert J Carpenter, DO, AAHIVS, FACP; Chief Editor: John Bartlett, MD  more...
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Answer

Answer

In 2008, a subset analysis of the Strategic Management of Antiretroviral Therapy (SMART) study found that although deferring treatment until the CD4+ T-cell count dropped below 200 cells/µL had been the standard of care, initiation of combined antiretroviral therapy at higher CD4 counts (>350 cells/µL) was associated with decreased morbidity and mortality in HIV disease. [11]

Similarly, the National Institutes of Health Comprehensive International Program of Research on AIDS (CIPRA) HT 001 clinical study showed that starting antiretroviral therapy at CD4 T-cell counts between 200-350 cells/µL improves survival compared with deferring treatment until the CD4 T-cell count drops below 200 cells/µL, which was the standard of care at the time. [12]

Interim analysis of CIPRA HT 001 showed that of 816 HIV-infected adults with early HIV disease, 6 of those who began antiretroviral therapy within 2 weeks of enrollment (early treatment) died, while 23 participants in the standard-of-care group died. [12] Among participants who began the study without tuberculosis infection, 18 individuals in the early treatment group developed tuberculosis, while 36 people in the standard-of-care group developed tuberculosis.

These interim results were statistically significant and led to ending the trial early to offer antiretroviral therapy to all participants in the standard-of-care group with a CD4+ T-cell count of less than 350 cells/µL. [12]

For these reasons, current Guidelines for the Use of Antiretroviral Agents in HIV-1–Infected Adults and Adolescents, published by US Department of Health and Human Services, recommend starting antiretroviral therapy for all individuals when infection is diagnosed, regardless of stage of infection, as long as barriers to therapy do not exist.

For discussion of antiretroviral drugs and regimens, see Antiretroviral Therapy for HIV Infection.


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