START (Strategic Timing of Antiretroviral Treatment)

One of the items that was up for discussion at the HIV Research Catalyst Forum was some new recommendations that is coming out of the U.S. HIV Treatment Guidelines Panel.  There is a suggestion from this panel that HIV Retroviral Medication should be started as soon as a person is diagnosed with HIV.  Here is exactly what they said in the latest Guidelines booklet that can be found HERE. 

Initiation of Antiretroviral Therapy


In this updated version of the guidelines, the Panel recommends earlier initiation of antiretroviral therapy with the following specific recommendations:


• Antiretroviral therapy should be initiated in all patients with a history of an AIDS-defining illness or with CD4 count < 350 cells/mm3 (AI).


• Antiretroviral therapy should also be initiated, regardless of CD4 count, in patients with the following conditions: pregnancy (AI), HIV-associated nephropathy (AII), and hepatitis B virus (HBV) coinfection when treatment of HBV is indicated (AIII).


• Antiretroviral therapy is recommended for patients with CD4 counts between 350 and 500 cells/mm3. The Panel was divided on the strength of this recommendation: 55% of Panel members for strong recommendation (A) and 45% for moderate recommendation (B) (A/B-II).


• For patients with CD4 counts >500 cells/mm3, 50% of Panel members favor starting antiretroviral therapy (B); the other 50% of members view treatment as optional (C) in this setting (B/C-III).
 
As you can see, this isn't something that was unanimously approved of.  A main reason for this hesitancy is that there really hasn't been any data or studies conducted that would link early HIV treatment to eliminating health complications later in life.  These recommendations were made because of a report that stated that there is a link between HIV and complications with heart, kidney, lung and even the brain.  They found that the lower a person's CD4 count reaches, the greater the chance in experiencing these health issues.  Hence, let's get people on medications as soon as they are diagnosed.   
 
But some advocates are against these recommendations.  There isn't any scientific study that is linking early treatment when CD4 count is above 500 to decreasing health problems.   There is a pilot program in the works now called S.T.A.R.T (Strategic Timing of Antiretroviral Treatment).  You can gather more information on it HERE. 
 
The START trial includes antiretroviral-naive HIV-positive people with CD4 counts greater than 500 cells/mm3. It is taking place at about 90 sites in nearly 30 countries. Participants are randomized to either receive antiretroviral treatment immediately or to defer treatment until their first CD4 count less than 350 cells/mm3 or they have clinical signs of AIDS. Eventually, START will recruit 4,000 people
 
What do you think about the new guidelines for HIV medication?