SUNDAY, July 18 (HealthDay News) -- Starting antiretroviral
treatment (ART) when an HIV patient has no symptoms can prevent the
progressive immune system destruction that leads to AIDS, according
to new treatment guidelines released by the International AIDS
The 2010 recommendations were written by a panel of experts who
reviewed new HIV data and research on timing of therapy, optimal
regimen choices and monitoring that has emerged since the
publication of the 2008 guidelines. There's also now more knowledge
about the effectiveness, toxicity and potential uses of newer drugs
in HIV management.
"The prominence of non-AIDS events as a major cause of morbidity and mortality in those with ongoing HIV replication suggests that early ART initiation may further improve the quality and length of life for persons living with HIV," the panel members wrote.
Patient readiness is a key consideration when doctors are
deciding to prescribe ART and there is no CD4 cell count level that
would prevent the initiation of therapy, they added.
CD4 cells are immune system cells targeted by HIV, so
concentrations (counts) of CD4 in blood are a key indicator of
According to the new guidelines:
- ART is recommended for patients without symptoms with CD4 cell
counts at 500 cells or less per microliter.
- ART should be considered for patients without symptoms with CD4
cell counts greater than 500 per microliter and is recommended
regardless of CD4 cell counts for patient who have established HIV
disease with symptoms.
- ART is also recommended for patients who are pregnant, older
than 60, or have an active or high risk for cardiovascular disease,
and for those with hepatitis B or C infections, HIV-associated
kidney disease, opportunistic diseases or symptomatic primary HIV
- ART should also be prescribed in cases where there is a high
risk for HIV transmission, such as couples with one HIV-infected
and one HIV-free partner.
- Once started, ART should be continued, except when being used
in a clinical trial.
- Risk-reduction counseling should be a routine part of
The new guidelines are scheduled for presentation at the
International AIDS Conference in Vienna on Sunday and will be
published in the July 21 HIV/AIDS theme issue of the
Journal of the American Medical Association.
"Far too many HIV-infected persons present for medical care with advanced disease, both in wealthy and resource-limited settings. Universal voluntary HIV testing, comprehensive prevention services, and early linkage to care and treatment are necessary to ensure that advances in ART are made available during earlier disease stages," the authors of the report wrote.
"Advances in ART have shown that AIDS, as traditionally defined, can be prevented. One of the greatest challenges is that full implementation of these guidelines will require addressing social and structural barriers to diagnosis and care, as well as the pervasive stigma and discrimination associated with an HIV diagnosis," they concluded.
The World Health Organization has more about