Sunday, August 1, 2010

When to start HAART in HIV


Well ,there has been no definite answers to this. CD4 count has been used to make the cut off. According to WHO,start if CD 4 count <350,>CASCADE (http://www.ctu.mrc.ac.uk/cascade/) group of investigators,on patients from their database tried to find an answer to this. Participants of the study were HAART-naive, AIDS-free, HIV-infected individuals between 1996 to 2009.Subjects were stratified by CD4 cell count. Those with cell counts above 800 cells/μL were excluded from the study.

The results of the study were presented in the AIDS 2010: XVIII International AIDS Conference in Vienna. Of 9455 patients with 52,268 person-years of follow-up, 812 (8.6%) developed AIDS and 544 (5.8%) died. Patients were followed up for roughly 5 years.

For those with CD4 0 to 49 cells/μL who started treatment,there was a 70% risk reduction,compared to those who were deferred treatment.

In those with CD4 cell counts between 200 and 349 cells/μL, there was 40% reduction in risk for disease progression or death.

for those with counts 350 to 499 cells/μL there was a 25% risk reduction in progression to AIDS/mortality.

There was no difference in risk of progression to AIDS in the 500- 799 cells/μL group.

Although this study did not include non HIV related deaths (eg.heart ,renal disease), it gives us a good evidence to start HAART at a CD4 count of <500>μL . The current WHO threshold of 350 cells/μL may be a little late in the progression of the disease to start HAART.

8 comments:

  1. Strong work SARNEL!

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