Lead researcher Dr. Mari M. Kitahata, of the University of Washington, Harborview Medical Center, Seattle and her colleagues based their recommendation on data of 17,517 Americans and Canadian HIV patients who received treatment from 1996 through 2005.

 

Currently, treatment is based on the number of CD4 immune system cells. The standard treatment had been a count of 200 per milliliter of blood and was recently raised to 350. US and Canadian researchers say treatment should begin when the CD4 count reaches 500. Infection with HIV is associated with a progressive decrease of the CD4+ T cell count and an increase in viral load. The stage of infection can be determined by measuring the patient's CD4+ T cell count, and the level of HIV in the blood.

 

The patients involved in the study were divided in two groups depending on their CD4 counts, one group had counts between 350 and 500 cells per milliliter, while the second group had patients with CD4 counts above 500.

 

The first analysis involved 8,362 patients: 25 percent of them began therapy when their CD4 counts from 350 to 500, while the other 75 percent delayed therapy until their CD4 counts fell below that. The patients who delayed therapy had a 69 percent greater risk of dying compared to those who began earlier treatment.
 

The second analysis involved 9,155 patients: 24 percent began treatment at CD4 counts of more than 500 cells per millimeter, while the other 76 percent delayed treatment until their counts fell below 500. These people had a 94 percent rise in risk of dying compared to the earlier therapy group.

“Our study adds to the growing evidence that support earlier initiation of therapy to improve survival. We think antiretroviral treatment should be started when the CD4 count is above 500. I feel these data are strong enough that I would start a patient who is ready and willing to begin therapy at a CD4 count above 500 and certainly between 350 and 500,” Kitahata said.

 

UNAIDS estimate the deadly virus has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive pandemics in recorded history. Sub-Saharan Africa remains the worst-affected region, with an estimated 21.6 to 27.4 million people currently living with HIV.

 

The majority of HIV infections are acquired through unprotected sexual relations between partners, one of whom has HIV. Only male and female condoms can reduce the risk of heterosexual HIV transmission. HIV affects nearly every organ system. Patients with HIV infection have substantially increased incidence of several malignant cancers and tuberculosis.