Discussion of when to start HIV treatment

[buginme2]

Joel Gallant and Paul Sax talk in a podcast on when to start HIV treatment.

The podcast is aimed at HIV doctors and providers but it's an interesting talk nonetheless.   They discuss when to start, when not to start, the difference in policy between the US and the UK.   

Surprisingly Paul Sax says the reason the US has moved to treat everyone and the UK hasn't is because the theory in the US everyone has access to treatment. 

http://www.thebodypro.com/content/67675/hiv-management-today-when-to-start-antiretroviral-.html

[Common_ground]

Interesting.

According to Gallant and Sax it seems that the reasons behind to not start treatment are based on solely non medical factors.

Another part which caught my eye was the way of looking at CD4 numbers as a predictor of the damage the virus is causing, maybe in the future we will take samples of other fluids/tissues or conduct test to determine our overall status?

[buginme2]

Interesting.


Another part which caught my eye was the way of looking at CD4 numbers as a predictor of the damage the virus is causing, maybe in the future we will take samples of other fluids/tissues or conduct test to determine our overall status?

I agree with that.  I think people get too focused on cd4 counts as a measure of health.  It's true that if your untreated a low cd4 count show immune impairment and a need to start treatment.  However, just because your cd4 hasn't dropped to some number doesn't mean HIV isn't causing damage.  Plus once your on treatment with a stable undetectable viral load cd4 counts have less meaning.  Other tests are better predictors of how you are doing and your state of health.  IMO

[newt]

Yes indeed surprisingly. If we buy the bit about the "very small" number without access to treatment in the US, the number in the UK is ZERO.

But the main reason the UK guidelines generally went for start about 350 is the writing committee had a higher standard of assessment for the evidence that the US committee, and this filtered out a big US study on early vs deferred treatment by the NA-ACCORD research group at John Hopkins. All the other evidence, on balance, suggests 350 or soon before that point has the best risk/befit ratio (the many, many exceptions UK guidelines allow notwithstanding).

- matt