Back to home » Top Stories » IAC 2010
XVIII International AIDS Conference
IAC 2010 XVIII International AIDS Conference
Reed Messe Wien
Vienna, Austria
July 18-23, 2010


Possibly No Survival Benefit to Starting HIV Treatment at CD4s of 500 or More

July 22, 2010

By David Evans

People who start antiretroviral therapy early—when their CD4 cell counts are 500 or greater—might not significantly lower their risk of AIDS or death over a three-year period compared with people who wait to start therapy when until their CD4 counts drop below 500. These data were presented Thursday, July 22, at the XVIII International AIDS Conference (IAC), taking place July 18 to 23 in Vienna.

In the past year, two major HIV advisory bodies—the U.S. Department of Health and Human Services HIV guidelines committee and the International AIDS Society-USA—have begun recommending that all people with CD4 counts below 500 should begin taking ARVs. Moreover, these groups also strongly urged providers to consider treating people at even higher CD4 counts.

Behind these recommendations is the growing acknowledgement that HIV is likely doing cumulative damage to the body even when CD4 counts are high. Such damage typically comes in the form of cellular inflammation, which can worsen the risk of developing cardiovascular disease and certain non-AIDS-related cancers. What remains unknown in people with high CD4 counts, however, is to what degree earlier treatment minimizes their risk for serious illness or death.

To explore this question, Joseph Eron, MD, from the University of North Carolina in Chappel Hill, and his colleagues, examined data from the CASCADE cohort study. CASCADE draws data from 23 smaller cohort studies in the United States, Europe, Australia and Canada.

The study, which began in 1996, has certain advantages over other cohort studies in terms of its ability to assess the risk of disease progression and mortality in people with HIV. Notably, unlike other studies where anyone with HIV is included, CASCADE only includes people who were recently infected with the virus. This means that researchers can more accurately assess how rapidly a person’s disease progresses following infection. It also means that when the CASCADE study looks at differences between people who start ARV treatment and those who don’t, there are less likely to be confounding factors that could skew the results.

In all, Eron and his colleagues’ analysis included data on 9,455 people who seroconverted to HIV positive between 1996 and 2008. Most were male, and the average age at seroconversion was 30 years old. Over time, 813 (8.6 percent) developed AIDS, and 544 (5.8 percent) died. The average follow-up time after seroconversion was 4.7 years.

Eron’s team broke the cohort into five groups for analysis: those with 0 to 49 CD4 cells, those with 50 to 199 cells, those with 200 to 349 cells, those with 350 to 499 cells, and those with 500 and 799. The team then tracked what happened to people if they began taking ARV treatment at each CD4 count range in a particular month at the time of that lasat CD4 count measurement or deferred treatment until a later time.

As has been documented in numerous studies, waiting to start ARV therapy is quite perilous for people who have less than 200 CD4 counts. Over a three-year period—in people with CD4 counts between 0 and 49—the cumulative risk of AIDS or death was 47 percent in people who deferred treatment compared with 17 percent in those who started. In those with CD4 counts between 50 and 199, the three-year risk was 21 percent in those who deferred therapy and 6 percent in those who started right away.

At higher CD4 counts, however, the benefits of therapy, in terms of AIDS and death rates, began to grow smaller. In those with CD4 counts between 200 and 349 who deferred treatment, the three-year cumulative AIDS or death risk was 10.3 percent, compared with 5.5 percent in those who started right away. In those with CD4 counts between 350 and 499 the difference was even smaller, 6.3 percent compared with 3.4 percent. For those with 500 or more CD4s, the difference in risk was almost identical—4.9 percent for those who waited and 5.2 percent for those who initiated treatment early.

The CASCADE data further suggest that at 350 to 499 CD4 cells, 34 people would need to be treated to prevent one new case of AIDS or death over a three-year period and that 71 would be needed to prevent one death. In those with 500 or more CD4s, there was no discernable benefit at all over the three-year period—though it is possible that a benefit would begin to become apparent over a longer period of time.

Eron acknowledged in his presentation that his group’s analysis does not take into account non-AIDS-related illness—one of the primary concerns driving the treatment guidelines changes for people with higher CD4 counts. Moreover, it is possible that people who were recorded as being on treatment actually took treatment interruptions or did not have fully suppressed virus. If this is true, it could mask the benefit of treatment, particularly at higher CD4 counts. Lastly, Eron cautioned against broadly generalizing these results for the average person living with HIV. Individualized care matters.

Search: CASCADE, early treatment, CD4, DHHS guidelines, inflammation, Joseph Eron

Scroll down to comment on this story.


(will display; 2-50 characters)


(will NOT display)


(will display; optional)

Comment (500 characters left):

(Note: The AIDSmeds team reviews all comments before they are posted. Please do not include ":" "@" "<" ">" in your comment. The opinions expressed by people providing comments are theirs alone. They do not necessarily reflect the opinions of Smart + Strong, which is not responsible for the accuracy of any of the information supplied by people providing comments.)

Comments require captcha.
Please enter this number for verification:

| Posting Rules

Show comments (1 total)

More from AIDS2010

HIV/AIDS Complications

July 28, 2010
Global Survey: Stigma, Isolation and Discrimination Still Pervasive
Universal HIV Treatment Access No Guarantee of Health for Socially Disadvantaged
July 27, 2010
OM-85 BV: A Bacterial Vaccine Against Respiratory Problems in People with HIV and COPD?
Low Vitamin D Levels Not Associated With HIV Drugs
July 23, 2010
Longer Duration of HIV Infection Might Increase the Risk of Brain Disorders
Nearly 75 Percent of People With HIV Might Have Bone Problems
July 22, 2010
Health Care Providers and People With HIV Not Communicating Effectively
July 21, 2010
Non-AIDS Cancers Occurring at Earlier Age Among People With HIV
Hep C Treatment Effective in HIV Patients With Normal Liver Enzymes
Aging Might Have a Smaller Impact on Immune Function Than Suspected
July 20, 2010
Viramune Boosts Hep C Treatment Efficacy in People With HIV
HIV/HCV Coinfection Further Increases Risk of Bone Fractures
Fewer Malignancies Seen in Those Taking Selzentry

Experimental HIV Drugs

July 23, 2010
More Details of TBR-652’s Antiviral and Anti-Inflammatory Potential Reported
July 22, 2010
ViiV HIV Integrase Inhibitor Performing Well in First-Time Treatment Study
Rilpivirine Has Similar Efficacy and Better Tolerability Than Sustiva
Extended-Release Viramune Has Comparable Safety and Efficacy to Standard Viramune
July 20, 2010
New ViiV Integrase Inhibitor Effective Against Some Isentress-Resistant HIV Strains
July 19, 2010
Argos’s Dendritic Cell Therapy Reduces HIV During Treatment Interruption

HIV Transmission and Prevention

July 29, 2010
Prevention Is Failing to Target MSM When They’re Young Enough
July 26, 2010
HPV Cancer Vaccine Effective for Heterosexual, Gay and Bisexual Men
Study Finds PrEP Is Safe in Gay and Bi Men
July 23, 2010
Circumcision Unlikely to Have Major HIV Prevention Benefit Among Gay Men
July 21, 2010
Microbicide Success Story: What It Means and Where We Go Next
MACS: Childhood Sex Abuse and Victimization Linked to Increased HIV Risk
Full-Scale HIV Treatment and Prevention Could Save Millions of Lives
July 20, 2010
Tenofovir Microbicidal Gel Significantly Cuts HIV Infection Rate
HIV Cases in Young People Are Falling Around the World
July 19, 2010
Preliminary Results Suggest Good Safety and Adherence Profile for PrEP

Starting and Switching Treatment

July 22, 2010
Reyataz/Isentress Combo Spares Norvir and Nukes, But Is Integrase Resistance a Concern?
Possibly No Survival Benefit to Starting HIV Treatment at CD4s of 500 or More
Once-Daily Prezista/Norvir Monotherapy Largely Effective Over 96 Weeks
Abacavir/Lamivudine Equivalent to Tenofovir/Emtricitabine in Canadian Cohort Study
July 19, 2010
Strategies for a Cure Reviewed in Vienna
Kaletra/Isentress Shows Promise as HIV Nuceleoside-Sparing Regimen for First-Line Treatment
Switch From Sustiva to Intelence Reduces Central Nervous System Side Effects
Protease Inhibitor-to-Isentress Switch is Effective, Lipid Friendly


July 22, 2010
Health Care Providers and People With HIV Not Communicating Effectively
July 20, 2010
Tenofovir Microbicidal Gel Significantly Cuts HIV Infection Rate
5.2 Million People With HIV in Low- and Middle-Income Countries Now on Treatment
At Least 31 Countries Deporting People Living With HIV
HIV Cases in Young People Are Falling Around the World

[ about AIDSmeds | AIDSmeds advisory board | our staff | advertising policy | advertise/contact us]
© 2014 Smart + Strong. All Rights Reserved. Terms of use and Your privacy.
Smart + Strong® is a registered trademark of CDM Publishing, LLC.