Times of India
28 January 2011
By Umesh Isalkar
The cut–off level to begin anti–retroviral treatment (ART) for people living with HIV (PLHIV) is set to be raised to 350 CD4 count from the existing 250. The move is expected to bring in better quality of living and help avert co–infections among the HIV infected.
"The current evidence in HIV management suggests that antiretroviral therapy should be recommended to those with HIV whose CD4 cell counts are below 350 cells/mm3, from the current threshold which is 250," said Sayan Chatterje, director–general of National AIDS Control Organisation (NACO). He was in the city to attend the three–day consultative meeting on ‘Galvanising Evidence for HIV Management’ that started at the National AIDS Research Institute (NARI) in Bhosari on Thursday.
There is widespread consensus that ART should be initiated when CD4 counts drop below 350, and this recommendation is supported by data from cohort studies and results from randomised control trials (RCT), he added. Standard antiretroviral therapy (ART) consists of the use of at least three anti–retroviral (ARV) drugs to suppress the HIV virus and stop its progress. "Huge reductions have been seen in rates of death and suffering when use is made of a potent anti–retroviral regimen," Chatterjee said.
B B Rewari, NACO’s national programme officer (ART), said, "The guidelines for administering ART which is at present given to HIV infected people with CD4 count less than 250 is all set to be revamped. It will be like the US once the cut–off level to get ART treatment is raised to 350 CD4 count."
An earlier start to antiretroviral treatment boosts the immune system and reduces the risks of HIV–related death and disease. It also lowers the risk of co–infection like tuberculosis, Rewari said. In 2006, WHO recommended that all patients start ART when their CD4 count (a measure of immune system strength) falls to 200 cells/mm3 or lower, at which point they typically show symptoms of disease. Since then, studies and trials have clearly demonstrated that starting ART earlier reduces rates of death and disease.
WHO has now recommended that ART be initiated at a higher CD4 threshold of 350 cells/ mm3 for all HIV–positive patients, including pregnant women, regardless of symptoms. "There is enough current evidence that suggest that the ART be initiated at a higher CD4 threshold of 350 cells/mm3. The recommendations churned out of this conference will serve to make policy decision in respect of the change in treatment guidelines," said Nari’s director Ramesh Paranjape.
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