HIV and ID Observations

May 27th, 2015

START is STOPPED: Study Confirms HIV Treatment Is Beneficial for All, Even Those with High CD4 Cell Counts

The Strategic Timing of AntiRetroviral Treatment (START) study began in 2009, enrolling over 4000 asymptomatic people with HIV and CD4 cell counts > 500, and randomizing them to immediate ART or to wait until the count dropped to 350. Now, from the National Institute of Allergy and Infectious Diseases comes this important announcement: Though the study was expected […]

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March 27th, 2012

Latest Guidelines Recommend HIV Treatment for All

From the key “What’s New in the Guidelines” section of today’s Department of Health and Human Services update: ART is recommended for all HIV-infected individuals. The strength of this recommendation varies on the basis of pretreatment CD4 cell count. This recommendation replaces a rather confusing categorization on when to start ART that, not surprisingly, was widely misinterpreted — […]

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January 8th, 2012

Journal Club: In Early HIV Infection, Little Reason to Delay Therapy

Every experienced HIV clinician will recognize the following new-patient scenario: At least one, but often several negative HIV antibody tests in the past, generally due to being in a “high risk” group. Recent non-specific viral-type illness that, in hindsight, was undoubtedly acute HIV infection, undiagnosed. Now completely recovered, but found to be newly HIV antibody positive. […]

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October 3rd, 2011

CASCADE: When to Start, (Yet) Another Take

As we await the enrollment, analysis, and results of the START study — which is randomizing patients with CD4>500 to start HIV therapy  vs waiting until the CD4 falls to 350 — much of the research on “when to start” ART in patients with high CD4’s comes from observational studies. Several have already been published […]

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April 18th, 2011

When to Start Antiretroviral Therapy, Take 3

A third observational study on “When to Start ART” has just appeared in the Annals of Internal Medicine,  “The HIV-CAUSAL Collaboration.” As with ART-CC and NA-ACCORD, it’s a large study, starting with over 20,000 people with HIV with baseline CD4s >500 receiving care in Europe and the United States.  Out of this group, 8392 experienced CD4 […]

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March 30th, 2011

Journal Club: Even When You Think You Should Wait, It’s Probably Time to Start

Two papers just published in AIDS with relevance to the “when to start” antiretroviral therapy question. Both apply to certain patients in whom we might consider waiting to start treatment– but both these studies suggest we do otherwise. The first applies to the patients with slooooow CD4 decline. Perhaps so slow that both you and your patient […]

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