Delaying Treatment Costs
posted: 14/01/2009
Researchers have now found that the immune systems of people who start HIV treatment at CD4 cell counts below 350 don’t recover as well as people who started HIV treatment at the recommended 350 level.
For some time now it has been recommended that people should start HIV treatment when the CD4 cell count is around 350. Starting treatment then rather than waiting until your CD4 cell count is lower, not only reduces the risk of developing HIV-related illnesses, but also reduces the risk of some other serious illnesses as well, for example heart, kidney, and liver disease as well as some cancers.
This research finding - that the immune systems of people who start HIV treatment at CD4 cell counts below 350 don’t recover as well - is true even when people had a good rise in their CD4 cell count following treatment.
The researchers found that the immune systems of people who started treatment with a CD4 cell count below 350 were similar to older people's.
As a person ages, the ability of the immune system to produce new CD4 cells falls. This partly explains why older people are more likely to get serious infections and cancers.
The researchers say this adds even more weight to starting treatment at CD4 cell counts around 350 and they suggest that just monitoring CD4 cell counts isn’t enough to assess the health of the immune system of people with HIV. Another useful test could include looking at the ratio of CD4 to CD8 cells.
Some can't start soon enough
But many people cannot start HIV treatment when their CD4 cell count is at 350. The main reason for this in the UK is late diagnosis of HIV. About one in three people who have HIV in this country don’t know they have HIV. Many people only have their HIV diagnosed when they are already ill because of HIV and have a low CD4 cell count.
And it’s a huge global issue as well – most people in resource-limited countries don’t start HIV treatment until their CD4 cell count is around 100.
Therefore the researchers suggest that new treatments to restore the immune system are needed for people who start treatment later than is recommended.
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