International AIDS Society

US Panel Recommends Starting ART Regardless of CD4 Count

Author: Mark Mascolini

30 March 2012

Antiretroviral therapy (ART) “is recommended for all HIV-infected individuals,” including those with a CD4 count above 500 cells/µL, the US Department of Health and Human Services (DHHS) panel advises in guidelines updated on 27 March 2012.

“The changes are primarily based on increasing evidence showing the harmful impact of ongoing HIV replication on AIDS and non-AIDS disease progression,” the panel notes. “In addition, the updated recommendations reflect emerging data showing the benefit of effective ART in preventing secondary transmission of HIV.”

The US panel strongly recommends starting ART for pregnant women and people with a history of an AIDS illness, HIV-associated nephropathy, or hepatitis B virus coinfection.

These experts also advise that anyone older than 50 start ART, regardless of CD4 count, “because the risk of non-AIDS related complications may increase and the immunologic response to ART may be reduced in older HIV-infected patients.”

They add that “a noteworthy limitation of currently available information is lack of data on the long-term safety of specific antiretroviral drugs in older patients, such as use of tenofovir disoproxil fumarate (TDF) in older patients with declining renal function.”

Because antiretroviral side effects occur more often in older people with HIV, the panel recommends close monitoring of bone, kidney, metabolic, cardiovascular, and liver health in older patients. But the panel does not recommend one initial regimen over another for older individuals.

Recommended first-line regimens remain the same: efavirenz or ritonavir-boosted atazanavir or ritonavir-boosted darunavir or raltegravir, each in combination with tenofovir/emtricitabine.

Source: HHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. 27 March 2012.

For the revised DHHS guidelines