October 31, 2008



When Should You Start Treatment?

I get a lot of questions from HIV positive people about when to start anti-HIV treatment. Now this is a subject matter which has changed many times over the past 22 years since AZT first came out.

In fact, I was at our monthly HIV community luncheon today and we talked about this during the luncheon. As always it was great seeing my friends from Northeast Florida AIDS Network along with the members of my community. Seeing them reminds me why I work so hard as an activist.

Now since I have been positive since 1982, the first four years of my infection there were no anti-HIV medications. Until 1996, the anti-HIV medications that were available were very toxic and usually did not keep people with HIV and AIDS alive for very long.

But now you have the choice of combining almost 30 different anti-HIV medications.

So when should you start now there is such a variety from which to choose?

Advantages to starting at a CD4 cell count of 500

It’s now recommended that you should start HIV treatment when your CD4 cell count is around 350. Starting treatment at this time, rather than waiting until your immune system is weaker, reduces your risk of becoming ill because of HIV and of some serious non-HIV-related illnesses as well.

There could, however be advantages to starting treatment even earlier. American researchers have found evidence that people starting treatment at even higher CD4 cell counts – between 350 and 500 – have a lower risk of death than those who start taking anti-HIV drugs when their CD4 cell count is in the region of 350.

The study was large and involved over 8000 people with HIV. Just under 2500 of these people started treatment when their CD4 cell count was between 351 and 500, the rest waited until their CD4 cell count was 350 or lower.

The researchers’ final results showed a clear advantage to starting treatment at higher CD4 cell counts. Patients who waited to start treatment had a higher risk of death than those who started treatment with CD4 cell counts between 350 and 500.

British researchers have previously found that starting treatment with a CD4 cell count of 500 is associated with a lower risk of death, and further studies are planned or underway to look at when’s the best time to start HIV treatment. What to start treatment with – Truvada outperforms Kivexa when used with a boosted-protease inhibitor

British HIV treatment guidelines recommend that people starting HIV treatment for the first time should do so with a combination of drugs that includes efavirenz (Sustiva) with either Truvada(FTC and tenofovir) or Kivexa(3TC and abacavir).

An alternative for some patients is to replace efavirenz with a ritonavir-boosted protease inhibitor.

Now researchers have found that when people take a boosted protease inhibitor, better results are seen with Truvada than Kivexa.

The researchers from Liverpool University looked at the results from almost 5000 patients who took part in twelve different clinical trials.

They found that patients who took Truvada alongside a boosted protease inhibitor were more likely to experience a sustained fall in their viral load to undetectable levels (below 50).

By working with your health care provider, you will be able to pick a combination that is best for you. Your doctor will do regular testing of your T-cells and viral load to monitor your progress and make adjustments as needed.

Here's wishing you a very long and healthy life.

Wishing you health, hope and happiness.

Big bear hug,

Daddy Dab