CLDF Title
Home | Contact Us | Bookmark
HBV HE HCC HCV
About CLDF Centers of Educational Expertise  
CME Dinner Meetings Telewebs Webcasts Slide Library Abstract Library Conference Highlights
 
Back  
 
Reuters Health Information (2009-04-07): Delaying anti-HIV therapy may prevent complete immune reconstitution

Clinical

Delaying anti-HIV therapy may prevent complete immune reconstitution

Last Updated: 2009-04-07 8:00:49 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Patients with HIV who are not started on highly activate antiretroviral therapy (HAART) until their CD4+ cell count dips below 200 cells/mm� may not achieve a normal CD4+ cell count, even after a decade of otherwise effective treatment, US investigators report in the March 15 issue of Clinical Infectious Diseases.

"A persistently low CD4+ cell count during treatment is associated with increased risk of both AIDS- and non-AIDS-related events (e.g., cardiovascular disease, liver disease, and cancer," Dr. Steven G. Deeks at the University of California, San Francisco, and co-authors point out. Only after counts are maintained above 500 cells/mm� is a patient considered to have a normalized immune status.

The research team evaluated 366 patients who had maintained plasma HIV RNA levels no higher than 1000 copies/mL for at least 4 years after starting therapy. Median follow-up was 7.5 years, with nearly a quarter of subjects followed for more than 10 years.

Almost all patients (95%) who started therapy with a CD4+ cell count of at least 300 cells/mm� were able to attain a CD4+ cell count at least 500 cells/mm�, the team reports. However, "44% of patients who started with a CD4+ cell count less than 100 cells/mm� and 25% of patients who started therapy with a CD4+ cell count of 100-200 cells/mm� were unable to achieve a CD4+ cell count greater than 500 cells/mm�."

Dr. Deeks and colleagues say "novel immune-based therapeutic approaches may be necessary to restore immunocompetence in these individuals."

In a related editorial, Drs. Boris Julg and Bruce D. Walker at Massachusetts General Hospital, Charlestown, note that major treatment guidelines recommend starting antiretroviral therapy when CD4+ cells counts fall below 350 cells/mm� -- difficult advice to follow in impoverished countries.

"However," they predict, "adequate early therapy, leading to more-complete immune reconstitution, may save resources because of the resulting lower incidence of opportunistic infections and reduced need for medical care."

Clin Infect Dis 2009; 48:787-797.

 
 
 
 
                 
 
HBV
Webcasts
Slide Library
Abstract Library
 
HE
CME Dinner Meeting
Webcasts
Slide Library
Abstract Library
 
HCC
Slide Library
Abstract Library
 
 
HCV
Webcasts
Slide Library
Abstract Library
 
CLDF Follow Us
   
 
About CLDF
Mission Statement
Board of Trustees
Board of Advisors
CLDF Supporters
 
Other Resources
Liver News Library
Journal Abstracts
Hep C Link to Care
 
Centers of
Educational Expertise
Regional Map
     
   
  The Chronic Liver Disease Foundation is a non-profit organization with content developed specifically for healthcare professionals.
© Copyright 2012-2014 Chronic Liver Disease Foundation. All rights reserved. This site is maintained as an educational resource for US healthcare providers only.
Use of this Web site is governed by the Chronic Liver Disease Foundation terms of use and privacy statement.