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Author Topic: Start ARV at CD4-500 or wait to 350 count?  (Read 4988 times)

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Offline yairsinho

  • Member
  • Posts: 47
Start ARV at CD4-500 or wait to 350 count?
« on: August 02, 2010, 11:07:19 AM »
 A friend of mine  is a about two of years Poz' and his Labs are going down to 500 CD4.
 He wanders if He have to ask for ART , or  letting the CD4 count sink down to 350.as some friends talk about.

What are the opinions in the USA ?
poz since 2002 (acute HIV infection)
Sustiva+Zerit+Videx
CD4 450 VL<50
2003 no meds
2005 decided to go back to meds
Sustiva+Viread+Epivir (behavior troubles)2005
Lexivia+Viread+Epivir+Norvir
Kaletra+Viread+ Epivir
Norvir+Prezista+Truvada April 2009
CD4 750  VL<50
Isentress+Truvada
cd4 700  vl<40

Offline newt

  • Member
  • Posts: 3,877
  • the one and original newt
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #1 on: August 02, 2010, 04:22:44 PM »
All guidelines say start if your CD4 count is 350 of below. Above 500 there is no certain discernable benefit (500+ CD4 means normal immune system). So a happy period of choice. The latest US guidelines panel was equally divided on the merit of treatment with CD4 500+, marginally in favour of starting between 350-500, and strongly in favour of treatment at 350 or below.

If older, like 40+ the imperative to start is  stronger since an important part of your immune regeneration process, the thymus, is less effective. Also the imperative is stronger if you have hepatitis coinfection, a high (20%+) risk of heart disease or "AIDS-defining" conditions (see CDC list).

Personally, if I was starting now, I would certainly start treatment before my CD4 count got to 350 and consider treatment after it fell below 500 for two consecutive tests. But I wouldn't rush, I'd try (as you can be) and be as ready as I could be.

- matt
"The object is to be a well patient, not a good patient"

Offline max123

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Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #2 on: August 02, 2010, 07:13:00 PM »


If older, like 40+ the imperative to start is  stronger since an important part of your immune regeneration process, the thymus, is less effective. Also the imperative is stronger if you have hepatitis coinfection, a high (20%+) risk of heart disease or "AIDS-defining" conditions (see CDC list).
- matt


newt,

given the above age related thymus issue, at what number would it be appropriate to consider medicating?
1/86 - 6/08 (annually): neg elisa
7/09: pos elisa/pos wb
8/09: cd4 560, cd4% 35, vl 13,050
12/09: cd4 568, cd4% 33, vl 2,690
4/10: cd4 557, cd4% 29.3, vl 6,440
7/10: cd4 562, cd4% 29.6, vl 3,780

Offline newt

  • Member
  • Posts: 3,877
  • the one and original newt
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #3 on: August 03, 2010, 02:00:45 AM »
No idea, there is no data, so your guess is as good as mine and as good as your doc's - matt
"The object is to be a well patient, not a good patient"

Offline yairsinho

  • Member
  • Posts: 47
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #4 on: August 03, 2010, 03:03:47 AM »
Thanks ,  'but I wander, as far as I know POZ people here, there are many going around the 350-380 for years, mostly because of the anti drugs trend,  or because the docs, that are pushing down the lower line
of 350/

I'm not saying , "Take the ART, even  if you are over the 500 line" , but if the guy goes down from 580' and  after 3 months is 530' and last labs goes 508....I say U can wait to the next test...NO PANIC...but what's the point to seat and wait till it goes down  and down' a year or more to the 350-370 line?
 It means, stay under the normal Immune level for a long time/
Whats the point?    Meds cost? Meds toxicity??

There was another trend, a few years ago, I stop my meds for more than a year.  "To spare my body the drugs negative dangerous side- effects....  Today, ARV drugs are not that toxic as then, and the doc's shelf is  full of bran new ones, less toxicity' less side effects...  I wander...and care..but no PANIC  :-)
poz since 2002 (acute HIV infection)
Sustiva+Zerit+Videx
CD4 450 VL<50
2003 no meds
2005 decided to go back to meds
Sustiva+Viread+Epivir (behavior troubles)2005
Lexivia+Viread+Epivir+Norvir
Kaletra+Viread+ Epivir
Norvir+Prezista+Truvada April 2009
CD4 750  VL<50
Isentress+Truvada
cd4 700  vl<40

Offline max123

  • Member
  • Posts: 377
  • Carpe Diem
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #5 on: August 03, 2010, 09:11:38 AM »
No idea, there is no data, so your guess is as good as mine and as good as your doc's - matt
got it. i was curious because i've read in numerous posts & articles that starting arv earlier in 40+ is suggested for the reasons you mentioned.but, nothing i've read gives any figures  on the recommended numbers ranges
1/86 - 6/08 (annually): neg elisa
7/09: pos elisa/pos wb
8/09: cd4 560, cd4% 35, vl 13,050
12/09: cd4 568, cd4% 33, vl 2,690
4/10: cd4 557, cd4% 29.3, vl 6,440
7/10: cd4 562, cd4% 29.6, vl 3,780

Offline Realist

  • Member
  • Posts: 162
    • NotDownNotOut's Blog
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #6 on: August 03, 2010, 12:03:38 PM »
This, released today, may be of interest:

http://www.aidsmap.co.uk/page/1497571/
23/02/10 Tests confirmed
25/02/10 13100 220 24%
12/03/10 19800 372 19%
26/03/10 Atripla
30/04/10 58 286 23%
28/05/10 45 222 21%
25/06/10 UD 301 23%
24/09/10 UD 283 22%
01/12/10 UD 319 23%
11/03/11 UD 293 28%
10/06/11 UD 423 24%
23/08/11 UD 389 26%
28/02/11 UD 315 34%

I blogged it all http://notdownnotout.blogspot.com

Offline max123

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  • Posts: 377
  • Carpe Diem
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #7 on: August 03, 2010, 12:21:53 PM »
This, released today, may be of interest:

http://www.aidsmap.co.uk/page/1497571/

very interesting reading...the potential multi-national changes on the horizon concerning arv therapy guidelines is quite compelling
1/86 - 6/08 (annually): neg elisa
7/09: pos elisa/pos wb
8/09: cd4 560, cd4% 35, vl 13,050
12/09: cd4 568, cd4% 33, vl 2,690
4/10: cd4 557, cd4% 29.3, vl 6,440
7/10: cd4 562, cd4% 29.6, vl 3,780

Offline yairsinho

  • Member
  • Posts: 47
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #8 on: August 03, 2010, 02:29:58 PM »
Thanks Realist for the link to the British Magazine!

Something I have to say' I do not know why some of you talk about old  positive guys
, my friend is 30 yo , so there is no any matter of age burden..:-)

Any how, I found the USA Health Dpt recommendations  from January 2010 :

http://www.thebody.com/content/art12720.html

For example, the U.S. government's Department of Health and Human Services HIV Treatment Guidelines (view PDF of guidelines) recommends that you begin HIV treatment if you have any serious symptoms, or before your T-cell count falls below 500. Some doctors prefer starting treatment if your T-cell count is above 500, in hopes that starting treatment a little earlier will help your immune system stay healthier

.
poz since 2002 (acute HIV infection)
Sustiva+Zerit+Videx
CD4 450 VL<50
2003 no meds
2005 decided to go back to meds
Sustiva+Viread+Epivir (behavior troubles)2005
Lexivia+Viread+Epivir+Norvir
Kaletra+Viread+ Epivir
Norvir+Prezista+Truvada April 2009
CD4 750  VL<50
Isentress+Truvada
cd4 700  vl<40

Offline max123

  • Member
  • Posts: 377
  • Carpe Diem
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #9 on: August 03, 2010, 02:43:05 PM »

Something I have to say' I do not know why some of you talk about old  positive guys
, my friend is 30 yo , so there is no any matter of age burden..:-)

yair,

you posted a question in a forum seen around the world that others can also comment upon. newt provided a response that included a general comment regarding age being a potential additional factor to consider in treatment guidelines, for completeness. i found such comment interesting and further queried. thats the way these forums work. no one was saying that your friend is an old guy, if thats what you consider those who are 40+ years old  :o

max
1/86 - 6/08 (annually): neg elisa
7/09: pos elisa/pos wb
8/09: cd4 560, cd4% 35, vl 13,050
12/09: cd4 568, cd4% 33, vl 2,690
4/10: cd4 557, cd4% 29.3, vl 6,440
7/10: cd4 562, cd4% 29.6, vl 3,780

Offline newt

  • Member
  • Posts: 3,877
  • the one and original newt
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #10 on: August 03, 2010, 09:59:07 PM »
Erm, I am now 46. I was a lot younger when I started treatment and am still here. I still get shagged too. This may annoy some people, but there you go. The important thing is to start treatment at some point and not stop.

- mattt  (in the womb when Kennedy was shot) the newt

Now playing: some contemporary French hip hop shit I don't like
"The object is to be a well patient, not a good patient"

Offline Hellraiser

  • Member
  • Posts: 4,136
  • Semi-misanthropic
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #11 on: August 03, 2010, 10:09:35 PM »
Erm, I am now 46. I was a lot younger when I started treatment and am still here. I still get shagged too. This may annoy some people, but there you go. The important thing is to start treatment at some point and not stop.

- mattt  (in the womb when Kennedy was shot) the newt

Now playing: some contemporary French hip hop shit I don't like


I think I speak for all of us here at Aidsmeds when I say "I'd shag you"

Offline yairsinho

  • Member
  • Posts: 47
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #12 on: August 04, 2010, 08:36:00 AM »
All right guys,
                     I didn't mean to hurt no one, any way, I"m 62 and still doing it!   from some old mag  own reasons
I guessed you pin pointed the 40+ factors in relation to my friends question.  That's why I wrote about  the very specific young age of Hem .   

 Guys hope you understand, English is not my strongest !  but as you say,Max, the Forum is seen even here,Near Tel Aviv !
poz since 2002 (acute HIV infection)
Sustiva+Zerit+Videx
CD4 450 VL<50
2003 no meds
2005 decided to go back to meds
Sustiva+Viread+Epivir (behavior troubles)2005
Lexivia+Viread+Epivir+Norvir
Kaletra+Viread+ Epivir
Norvir+Prezista+Truvada April 2009
CD4 750  VL<50
Isentress+Truvada
cd4 700  vl<40

Offline Azrael2012

  • Member
  • Posts: 43
  • Say Hello! :D
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #13 on: April 05, 2011, 08:21:49 PM »
I started mine at 380.....and it was after a bout of pneumonia, best thing I ever did....went undetectable in 3 weeks and my CD4 is now at 776 and thats after being on Atripla for 18 months....everyone is different, talk it over with your Doctor but dont be bullied into starting if you dont feel you arent ready...after all, its you who is on the meds not the Doctor!

Offline sam66

  • Member
  • Posts: 277
  • Keep The Faith ; Fight The Fight
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #14 on: May 04, 2011, 11:37:09 AM »
 From     THE BODYPRO

Initiating Anti-HIV Therapy at High CD4 Count Increases AIDS-Free Survival

From U.S. Centers for Disease Control and Prevention

April 28, 2011


Starting combination antiretroviral therapy (ART) at the threshold of 500 CD4 cells/microliter, rather than at 350 or lower, significantly reduces HIV patients' risk of progressing to AIDS, a new study shows.

US recommendations indicate treatment at the 500-cell point for asymptomatic HIV patients, while European and World Health Organization guidelines call for treatment at the 350-cell level. The authors of the current study -- Dr. Lauren E. Cain, with the Harvard School of Public Health, and colleagues -- said information from randomized trials is inadequate to decide between the two approaches, and two large observational studies have yielded conflicting results.

    Compared with starting ART at the threshold of 500 CD4 cells/microliter, the hazard ratios of AIDS-defining illness or death were 1.38 at the 350-cell level and 1.90 at 200 CD4 cells. Also compared to initiating therapy at the 500-cell threshold, the overall mortality hazard ratio was 1.01 at 350 cells and 1.20 at 200 cells.

The results demonstrate the advantages of early testing as well as early treatment, the authors wrote.

   http://www.thebodypro.com/content/news/art61737.html

december 2007 diagnosed +ve ,

Offline Ac75088

  • Member
  • Posts: 228
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #15 on: May 04, 2011, 03:34:29 PM »
I started in the middle...around 415...that was yesterday.
01-12-08 Tested poz cd4 700 vl 8,000
04-25-11 Lowest cd4 count of 415 vl high at 250,000
05-03-11 Started Atripla
05-16-11 Hospitalized and treated for 2 weeks (neurosyphilis)
07-05-11 CD4 count 585 VL 550
10-04-11 CD4 count 700 VL 75
02-03-12 CD4 count 799 VL UD
08-08-12 CD4 count 838 VL UD

Offline newt

  • Member
  • Posts: 3,877
  • the one and original newt
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #16 on: May 04, 2011, 04:25:23 PM »
There is a complete write-up of the Cain et al (HIV-CAUSAL cohort collaboration, about 50 people) here:

http://www.aidsmap.com/Starting-HIV-treatment-when-CD4-cell-count-dips-below-500-improves-AIDS-free-survival/page/1771387/

It's a valuable study. For me important messages are:

1. The risk of death from any cause cannot be said to be different between CD4 of 500, 350 and 200.

2. There is a modestly lower risk of having an AIDS-defining illness if you start at a higher CD4 count << but in absolute terms this is not huge reduction in risk, and some people get em at CD4 count 500...

3. No comment is possible on risk of having a non-AIDS illness << which is to my mind is important, at least as important long-term as anything else, and hopefully what START and other studies will make possible.

4. The study should be treated with "caution," and that doctors should have "frank conversations with their patients about what we do and what we don't know about starting cART [meds]." (authors own words in accompanying editorial in original journal).

Very much like the comment in a previous post: everyone is different, talk it over with your doctor ... after all, its you who is on the meds.

- matt
"The object is to be a well patient, not a good patient"

Offline danitheches

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  • Posts: 17
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #17 on: May 11, 2011, 10:18:07 AM »
A friend of mine  is a about two of years Poz' and his Labs are going down to 500 CD4.
 He wanders if He have to ask for ART , or  letting the CD4 count sink down to 350.as some friends talk about.

What are the opinions in the USA ?


Start and stick with it. 

Offline elf

  • Member
  • Posts: 596
Re: Start ARV at CD4-500 or wait to 350 count?
« Reply #18 on: May 13, 2011, 10:50:49 PM »
I started at CD4 of 353 (well this was the number at my diagnosis, and I started therapy 2 days later),
and had no problems at staying at CD4 of 1000 (+/-300).

But my CD4 of 353 was 6 months after getting infected,
so I don't know how it would work if I had been infected for 10 years...  :-\

I don't know.
If your infection is recent, maybe you should wait for a while,
but if you think your infection is not recent, you should start your therapy regardless of your CD4 #.
Let's have a Kiki!

 


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