AIDSWEEKLY Plus; Monday, November 17, 2003
Staff Medical Writers

"We assessed the risk of acquired immunodeficiency syndrome (AIDS)-related opportunistic illness or death among persons first prescribed highly active antiretroviral therapy (HAART) in January 1996 or later in the Centers for Disease Control and Prevention's Adult and Adolescent HIV Spectrum of Disease Project. Patients were included if they were naive to antiretroviral drugs and had no history of AIDS-related opportunistic illness," researchers in the United States report.

"Risk was assessed as a function of CD4+ lymphocyte count and human immunodeficiency virus load at the time of initiation of HAART in a Cox proportional hazards model," stated Jonathan E. Kaplan and fellow members of the Adult and Adolescent Spectrum of HIV Disease Project Investigators. "Hazard ratios for AIDS or death were 6.3, 3.5, and 1.7 for persons with baseline CD4+ cell counts of 0-49, 50-199, and 200-349 cells/microliter, respectively, compared with the referent (CD4+ cell count greater than or equal to500 cells/microliter)."

"HAART should not be deferred until the CD4+ cell count reaches <200 cells/microliter," recommended Kaplan and his colleagues. "The increased hazard associated with CD4+ cell counts of 200 - 349 cells/microliter was modest but supports initiation of HAART at CD4+ cell counts <350 cells/microliter, particularly in patients with high virus loads."

Kaplan and his coauthors published their study in Clinical Infectious Diseases (When to begin highly active antiretroviral therapy? Evidence supporting initiation of therapy at CD4+ lymphocyte counts <350 cells/microliter. Clin Infect Dis. 2003 Oct 1;37(7):951-8.

For additional information, contact Jonathan E. Kaplan, Surveillance and Epidemiology, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Mailstop A-12, Atlanta, GA 30333, USA. E-mail: jxk2@cdc.gov.

Publisher contact information for the journal Clinical Infectious Diseases is: University of Chicago Press, 1427 East 60th Street, Chicago, IL 60637-2954, USA.

The information in this article comes under the major subject areas of AIDS and HIV Therapy, Immunology, Immunotherapy, Sexually Transmitted Disease, Anti-Infectives, and Virology.

This article was prepared by AIDS Weekly editors from staff and other reports.

Reference

Kaplan JE, Hanson DL, Cohn DL, et al., "When to begin highly active antiretroviral therapy? Evidence supporting initiation of therapy at CD4+ lymphocyte counts <350 cells/microL", Clin Infect Dis. 2003 Oct 1;37(7):951-8.

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