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AIDS-Free Survival Affected by CD4 Count at Start of cART

Last Updated: April 19, 2011.

Combined antiretroviral therapy initiated at a threshold of 0.500 × 109 cells/L may increase the rate of AIDS-free survival compared to initiation at lower thresholds, but does not affect mortality, according to a study published in the April 19 issue of the Annals of Internal Medicine.

TUESDAY, April 19 (HealthDay News) -- Combined antiretroviral therapy (cART) initiated at a threshold of 0.500 × 109 cells/L may increase the rate of AIDS-free survival compared to initiation at lower thresholds, but does not affect mortality, according to a study published in the April 19 issue of the Annals of Internal Medicine.

Lauren E. Cain, Ph.D., from the Harvard School of Public Health in Boston, and colleagues evaluated the optimal CD4 cell count at which cART should be initiated. A total of 8,392 HIV-infected, therapy-naive individuals whose CD4 cell count decreased from at or above 0.500 × 109 cells/L at baseline to 0.200 to 0.499 × 109 cells/L, with no previous AIDS-defining illnesses, were included in the analysis. Hazard ratios and survival proportions for all-cause mortality were measured from the point at which the CD4 cell count dropped below 0.500 × 109 cells/L, and the study's combined end point was AIDS-defining illness or death.

The investigators found that the mortality hazard ratio was 1.01 for those initiating cART at a CD4 cell count threshold of 0.350 × 109 cells/L, and was 1.20 for those initiating at 0.200 × 109 cells/L, compared to the threshold of 0.500 × 109 cells/L. The corresponding hazard ratios for the end points of AIDS-defining illness or death were 1.38 for a threshold of 0.350 × 109 cells/L and 1.90 for a threshold of 0.200 × 109 cells/L.

"Delaying initiation until the CD4 cell count decreased below 0.350 × 109 cells/L did not seem to substantially affect overall mortality. The benefits of early initiation cannot be fully realized if most persons present for medical care with CD4 cell counts below 0.500 × 109 cells/L; thus, early HIV testing would be beneficial," the authors write.

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