Word: cd4
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...positive patients who were being treated by physicians from 22 different research groups in 60 cities in North America between 1996 and 2005. She and her team essentially conducted two trials. In one, the scientists looked at patients who chose to initiate ART when their level of CD4 cells - infection-fighting immune cells that HIV uses to replicate and then systematically destroys - ranged between 351 and 500 cells per cubic mm of blood. These patients were compared with those who decided to defer therapy until their counts dipped below 350 cells per cubic mm, the level at which current guidelines...
...second study, Kitahata's team looked at patients who chose to start ART when their CD4 count was 500 or above and compared them with patients who decided to defer treatment until their CD4 counts dropped below 500 cells. (In a normal, healthy adult, CD4 levels range from 600 to 1,200.) In both studies, the patients deferring treatment were more likely to have died by the 2005 end of the study than were their earlier-treated cohorts. HIV-positive patients beginning therapy at CD4 levels between 351 and 500 cells were 69% more likely to be alive...
...fact, when the potent ART combination therapy first emerged in the mid-1990s, government health officials recommended that anyone with a CD4 count of 500 cells or lower receive treatment. But in response to growing concerns over HIV's increasing ability to become resistant to the drugs, as well as worries over the drugs' toxicity and patients' inconsistent compliance with their regimen, the guidelines dropped to 200 before eventually settling at 350 cells - much further along in the progression of the disease...
...convincing and as large as the current study is, Fauci notes that it too lacks this scientific imprimatur. In Kitahata's study, researchers followed patients as they and their doctors made their own decisions about when they would begin drug therapy. Those who chose to start early - before their CD4 counts reached 350 cells or 500 cells, for instance - may have simply been more health-conscious overall and therefore less likely to die, which could have confounded the study's results. Only a randomized and controlled trial in which patients are arbitrarily assigned either to initiate or defer therapy could...
...will make it. He has had side effects to a log of the meds. When I first saw him, I told him and his father that he will play and have fun again. I had my doubts - until last week. [After being on a different combination of drugs], his CD4 count shot up and his family and I have hope. He still hasn't smiled, but I have hope...