There has been much discussion about when to start treatment for HIV after infection. The current guidelines state that people should start treatment before their CD4 count drops below 350-500. The threshold CD4 count for starting treatment used to be much lower but more and more research has shown that there is a benefit in starting treatment early. Now, a new study published recently in JAMA Internal Medicine has concluded that in order to maximise chances of full immune recovery treatment should ideally be commenced within 12 months of infection

Doctors have to carefully balance the potential benefits and risks of starting treatment. On the one hand, starting early is beneficial in terms of maximising immune function, but the benefit has to be weighed up against the risks and potential side effects of people being on treatment for longer periods. Different doctors will give different advice as to when they would initiate treatment. The recent study is helpful in that it specifically looked at the influence of ART timing on the normalisation of CD4 counts, immune function and the risk of progressing to AIDS. This might help make the decision about when it initiates ART (Antiretroviral Therapy) , easier.

The study involved over 1000 HIV-infected patients with documented dates of seroconversion. They all had virological suppression following the initiation of ART.

When to start HIV treatment ( ART)?

The authors concluded that “Deferral of ART beyond 12 months after the estimated date of seroconversion diminishes the likelihood of restoring immunologic health in HIV 1 infected individuals”

They state that “if the goal of HIV treatment is immunologic health then normalisation of CD4 counts is an important target “

The study concluded that CD4 normalisation is retained if the duration of untreated HIV infection is short and ART is started with CD4 above 500. In patients with CD4 count above 500 who only started ART more than 12 months after infection this advantage was diminished

This reinforces the fact that regular testing to spot recently infected individuals is very important in order to give these patients the option of starting treatment sooner rather than later to give them the best chance of restoring their immune function to normal levels and maintaining good health.

Get yourself tested regularly and keep yourself healthy!