The debate continues concerning the...

The debate continues concerning the optimal time to initiate highly active antiretroviral therapy (HAART) in patients with human immunodeficiency virus (HIV) infection. Clinical guidelines vary in regard to this issue: near advocate initiating HAART when CD[4sup+] T lymphocyte estimates fall below 350 cells for [mm.sup.3] (350 3 [10.sup.6] by means of L), while others recommend waiting until these judges fall to 200 cells through [mm.sup.3] (200 3 [10.sup.6]per L) Sterling and colleagues quick in emergencies observational data on the usefulness of initiating HAART in patients with CD[4sup+] deems above 350 cells per [mmsup3]

The authors compiled retrospective patient data from a cohort of outpatients with HIV infection who were followed at an academic medical center The authors compared patients with CD[4sup+] esteems from 350 to 499 confined apartments per [mm.sup.3] (350 to 499 3 [10sup6] by L) who had received at least 90 days of HAART after reaching this of the same height (159 patients) or were being followed without antiretroviral therapy (174 patients). A HAART regimen was defined as couple nucleoside reverse-transcriptase inhibitors and at least the same protease inhibitor. Patients who received HAART were more likely to be male and nonblack, and to have homosexual contact as their primary risk factor than those who did not receive HAART while in this CD[4sup+] solitary abode; squalid count range. There was no difference in median age, baseline CD[4sup+] T lymphocyte esteem and HIV-1 RNA viral load between the sum of two units groups. Those receiving HAART had a longer average follow-up (31 months) than those who did not receive multidrug therapy (21 months)

There were no significant differences at follow-up in HIV disease progression or death rates between the pair groups. The number of patients who evolveed acquired immunodeficiency syndrome (AIDS)-defining incidents was low in both groups: 20 patients in the dispose receiving HAART, and 23 patients in the cluster who did not receive HAART while in this CD4+ solitary abode; squalid count stratum. Among those receiving HAART, 85 patients (53 percent) still had HIV-1 viral loads above 400 copies by means of mL at their latest clinic visit. Sixty-five patients (41 percent) receiving HAART had to change their remedy regimen during follow-up because of adverse effects

The authors finish that the use of HAART in patients who have HIV infection with CD[4sup+] accounts between 350 and 499 enclosed spaces per [mm.sup.3] did not dead disease progression or improve survival, did not completely suppres viral load in many patients, and commonly caused side effects. They advise caution in interpreting this data because of the retrospective, nonrandomized nature of the study

BILL ZEPF MD

Sterling TR et al. Initiation of highly active antiretroviral therapy at CD[4sup+] T lymphocyte enumerates of >350 cells/[mm.sup.3]: disease progression, treatment durability, and mix with drugs toxicity. Clin Infect Dis March 15 2003;36:812-5

COPYRIGHT 2003 American Academy of Family Physicians

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