Start treatment at a CD4 cell count of 500 to reduce risk of serious non-HIV-related illnesses? Treatment guidelines (such as those in Europe and the US) are now recommending that HIV treatment should be started when an individual’s CD4 cell count is around 350 cells/mm3. Previous guidelines recommended the initiation of treatment when a patient’s CD4 cell count was around 200 cells/mm3.

These were changed when studies showed that patients who started treatment at higher CD4 cell counts had much better long-term improvements in their immune system. Furthermore, results from the SMART treatment interruption study showed that a low CD4 cell count increased the risk of serious non HIV-related illness, such as some cancers as well as heart, kidney and liver disease.

But could treatment guidelines soon be recommending starting treatment at an even higher CD4 cell count? There is evidence from the UK that patients with a CD4 cell count of 350 cells/mm3 have more HIV-related illnesses and a greater risk of death than patients with a CD4 cell count of 500 cells/mm3.

Prof Andrew Phillips of London’s Royal Free Hospital analysed results from a number of studies showing that HIV may have an important role in some serious non-HIV-related illnesses. He suggested that the earlier use of antiretroviral therapy could reduce the risk of these illnesses.

“We need to be looking at whether antiretroviral therapy should be initiated earlier in patients with CD4 cell counts above 500 [cells/mm3]”, Prof Phillips told CROI delegates.

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