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| |  HIV Patients With Highest CD4 Counts Fail to Gain Benefit From Potent Antiretroviral Therapy: Presented at AIDS 2010 By Ed Susman VIENNA -- July 27, 2010 -- Treating patients with HIV infection when their marker of immune constitution is still high does not appear to result in better outcomes, researchers stated here at the 18th International AIDS Conference. For patients who had CD4-positive cell counts between 500 and 799 cells/mcL, immediate treatment was not associated with a significant reduction in risk of death (adjusted hazard ratio: 1.02 (confidence interval [CI], 0.49-2.12). "At CD4-positive cell counts of 500 to 799 cells/mcL, we saw no apparent benefit to initiation of treatment for the larger proportion of patients," stated Joseph J. Eron, Jr, MD, University of North Carolina, Chapel Hill, North Carolina, speaking here at his oral late-breaker presentation on July 22. "At a CD4-positive cell count of 350 to 499 cells/mcL, we would have to treat 34 patients to avoid 1 case of AIDS or death over a 3-year period," he added. In the study, Dr. Eron and colleagues analysed patients who were enrolled in 23 clinical cohorts early in their seroconversion to HIV and who were free of AIDS-defining events. All subjects had not received highly active antiretroviral therapy (HAART) and were over 13 years of age. At least 6 months had passed since their estimated seroconversion date. The researchers identified 9,455 patients who fit the criteria for entry into the study; about 76% of the patients in the study were male, and the average age at time of seroconversion was 30 years. Over a median follow-up of 4.7 years, 812 of those patients developed AIDS and 544 died. Among the other results, Dr. Eron said that by immediately treating patients with the lowest CD4-cell counts -- those with <50 cells/mcL -- 1 AIDS event or death could be avoided by treating 3 people with antiretroviral therapy. The number to treat for patients with 50 to 199 CD4-positive cells/mcL was 7. The number to treat for patients with 200 to 349 CD4-positive cells/mcL was 21. Given the relatively small decrease in risk among those with CD4 counts of 350 to 499 cells/mcL, patients and healthcare providers need to weigh the risks and benefits of HAART initiation over an extended period of treatment. [Presentation title: HAART Initiation and Clinical Outcomes: Insights From the CASCADE Cohort of HIV-1 Seroconverters on 'When to Start'. Abstract THLBB201]
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