At what CD4 count should someone start on ART?
Jun 28, 2009
THE earlier guidelines by the World Health Organisation for starting people on ARVs in resource limited countries gave 200 cells/ml as the cut-off point.
Face HIV with Dr. Watiti
Dear Doctor,
Which is the correct CD4 count for someone to start taking ARVs? My sister who is HIV-positive was started on the drugs when her CD4 count was 350, yet she had no complaints at all. Is this correct? I thought people start using ARVs when their CD4 count falls to 200 cells/ml and below.
Beatrice
Dear Beatrice,
THE earlier guidelines by the World Health Organisation for starting people on ARVs in resource limited countries gave 200 cells/ml as the cut-off point.
This is because at this stage and below most people living with HIV fall sick with opportunistic infections and therefore need to be started on antiretroviral therapy (ART).
This has now been revised because new evidence shows that people who start on ARVs early do much better than those who start when their immune system has been badly damaged over a period of time.
In western countries, people are started on ART as soon as they are diagnosed with HIV and so a number of them no longer die of AIDS as is still the case in Africa.
We need to routinely check all patients who visit health care facilities for HIV testing.
Those who test positive should start treatment in due course instead of waiting until they are sick to initiate ART.
Treating people early is also a form of preventing new infections as evidence shows that people on ARVs with good adherence and maximal viral suppression are not as infective as those who are not.
Dear Doctor,
Which is the correct CD4 count for someone to start taking ARVs? My sister who is HIV-positive was started on the drugs when her CD4 count was 350, yet she had no complaints at all. Is this correct? I thought people start using ARVs when their CD4 count falls to 200 cells/ml and below.
Beatrice
Dear Beatrice,
THE earlier guidelines by the World Health Organisation for starting people on ARVs in resource limited countries gave 200 cells/ml as the cut-off point.
This is because at this stage and below most people living with HIV fall sick with opportunistic infections and therefore need to be started on antiretroviral therapy (ART).
This has now been revised because new evidence shows that people who start on ARVs early do much better than those who start when their immune system has been badly damaged over a period of time.
In western countries, people are started on ART as soon as they are diagnosed with HIV and so a number of them no longer die of AIDS as is still the case in Africa.
We need to routinely check all patients who visit health care facilities for HIV testing.
Those who test positive should start treatment in due course instead of waiting until they are sick to initiate ART.
Treating people early is also a form of preventing new infections as evidence shows that people on ARVs with good adherence and maximal viral suppression are not as infective as those who are not.