Using baseline CD4 cell count and plasma HIV RNA to guide the initiation of highly active antiretroviral therapy.
Rev Invest Clin
; 56(2): 232-6, 2004.
Article
em En
| MEDLINE
| ID: mdl-15377076
Conflicting evidence regarding the impact of baseline plasma HIV RNA and CD4 cell count on survival after the initiation of highly active antiretroviral therapy (HAART) in HIV-infected patients has resulted in wide variability in the expert recommendations regarding when to start therapy. Early initiation of HAART may result in avoidable toxicities and premature evolution of resistance, whereas delaying HAART may increase the risk of opportunistic infections and/or preclude a worse virological and clinical response to therapy. While there is widespread consensus that HAART can be delayed to a CD4 cell count of 0.350 x 10(9) cells/L, the range between this threshold and 0.200 x 10(9) cells/L remains controversial. Greater uncertainty surrounds the role of baseline plasma HIV RNA, with some guidelines recommending initiating HAART when this level rises above 55,000 c/mL regardless of baseline CD4 cell count. The following review examines the evidence in support of delaying the initiation of HAART to a CD4 cell count of 0.200 x 10(9) cells/L regardless of plasma HIV RNA levels and outlines supporting data from a Canadian prospective cohort study of antiretroviral naive patients treated with HAART.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
RNA
/
Infecções por HIV
/
HIV
/
Terapia Antirretroviral de Alta Atividade
Tipo de estudo:
Guideline
/
Observational_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
Rev Invest Clin
Assunto da revista:
MEDICINA
Ano de publicação:
2004
Tipo de documento:
Article
País de afiliação:
Canadá
País de publicação:
México