Washington Post (01.07.07) - Tuesday, January 09, 2007
David Brown

"Universally, people feel this is an important question," said Dr. Anthony S. Fauci, head of the National Institute of Allergy and Infectious Diseases, which will consider the request.

No one is certain when the tradeoff between quality of life, cost, self-image, potential adherence burden or adverse affects from long-term HAART start to tip toward the life and health advantages of initiating HAART. Researchers have known for years to begin HAART at least by the time a patient's CD4 lymphocytes fall to 200 per microliter of blood, below which patient mortality rates increase.

But at what point above 200 should HAART begin? The US government and World Health Organization recommend HAART when a patient's CD4 count falls between 350-200. Some doctors believe HAART may best be started at 500. A healthy CD4 count is approximately 750.

In the international study proposed, patients with CD4 counts over 500 would randomly begin HAART either immediately or wait until the counts were 300-350. The second arm would enroll patients with lower CD4 counts and randomly assign them to immediate HAART or wait until counts were 200-250.

Now that newer HIV drugs come in simpler dosing schedules, have fewer side effects, can be combined in hundreds of regimens, and are not likely to improve much in the near future, it has become more imperative to answer the question of when to initiate HAART.
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