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Session 21
Symposium Controversies in Antiretroviral Therapy Session Time: Tuesday, 7 - 9 pm Room 4B |
Background: Treatment guidelines for HIV infection have changed substantially in the past several years. Earlier guidelines endorsed beginning treatment early, based on the assumptions that infection might be eradicated, that response would be better in less advanced disease, and that adverse reactions would be less common than in later stage disease. Earlier criteria for starting therapy included CD4 count <500 and viral load >25-40,000. It is now apparent that HIV infection cannot be eradicated from cellular reservoirs with current therapy. In addition, data from observational cohorts demonstrate that patients started on therapy with CD4 counts as low as 200 respond as well as those started earlier in terms of immune reconstitution, reduction of disease risk, and survival, while those started with CD4 counts <200 are at higher risk of disease progression. Conclusions: Delaying treatment in patients with CD4 counts >200 does not appear to increase risk of progression. Viral load, while highly predictive of progression in untreated HIV disease, does not predict clinical response to antiretroviral therapy. Patients started on antiretroviral therapy with CD4 counts >350 are likely to experience considerable toxicity as well as emergence of drug-resistant virus in the absence of a compelling clinical benefit. Initiation of therapy should be based on CD4 count and the patient’s ability to comply with complex and potentially toxic regimens. |
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©2002 9th Conference on Retroviruses and Opportunistic Infections |
