DrVirgo
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As of 2006-2007:
Guidelines for starting therapy in HIV+ patients are:
CD 4 count <350 OR Viral Load (PCR RNA) >55,000
Is this still the recommended guideline or has it changed?
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| janan
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Don't think it's changed..see this page..
http://www.atdn.org/simple/guidelines.html
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| DrVirgo
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I don't think so...
That site says:
If you are recently infected or if you have symptoms of HIV disease (symptomatic) or if you have 350 or fewer CD4 cells - also referred to as T4 or T cells - you should seriously consider starting HIV treatment as soon as possible, especially if you are losing CD4 cells quickly or have a high HIV viral load ( measured by an HIV PCR).
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| DrVirgo
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Panel’s Recommendations:
• Antiretroviral therapy should be initiated in patients with a history of an AIDS-defining illness or with a CD4 T-cell count <350 cells/mm3. The data supporting this recommendation are stronger for those with a CD4 T-cell count <200 cells/mm3 and with a history of AIDS (AI) than for those with CD4 T-cell counts between 200 and 350 cells/mm3 (AII).
• Antiretroviral therapy should also be initiated in the following groups of patients regardless of CD4 T-cell count:
a. Pregnant women (AI);
b. Patients with HIV-associated nephropathy (AI); and
c. Patients coinfected with HBV when treatment is indicated (BIII).
• Antiretroviral therapy may be considered in some patients with CD4 T-cell counts >350 cells/mm3. (See text for further discussion.)
• The necessity for patient adherence to a long-term drug regimen should be discussed in depth by the patient and clinician (AIII). Barriers to adherence should be addressed before therapy is initiated.
The above info is from:
http://aidsinfo.nih.gov/contentfiles/AdultandAdol...
The don't say anything about viral load though.
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| arlete
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uw still have a question in its q-bank for step 3 stating that we treat according to viral load, too. So I think it's still used.
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| peter90036
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yeah Dr. V the most recent HIV info in at aidsinfo.nih.gov/guidelines
pg13
This study also demonstrated that baseline viral load was not significantly associated with risk of AIDS or death. However, patients with high viral loads 6-months posttreatment were found to have higher rates of disease progression, which indicates that virologic response to antiretroviral therapy remains a critical factor in monitoring ART.
pg14
The level of HIV RNA in a patient with a higher CD4 T-cell count is not strongly associated with short-term risk of AIDS/death and is a less important criterion for initiation of therapy than the CD4 T-cell count. Nevertheless, a high viral load is a predictor of more rapid progression to AIDS overall. Some experts may take viral load into consideration when deciding whether or not to start therapy in patients with CD4 T-cell counts >350
so it looks like viral load is just to get a baseline at start of treatment and use it for monitoring tx efficiency.
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| WaqasQureshi
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There are definite guidelines for:
- Symptomatic (AIDS or severe symptoms): start the therapy NO MATTER whatever the viral load and CD 4 bla bla is.
- Asymptomatic with CD4 <200
Almost definite guidelines:
- Asymptomatic but with CD4 200-350
SOME PHYSICIANS RECOMMEND:
Asymptomatic with CD4 >350 and viral load >55000 too as in untreated patients the risk to progress into AIDS is 30%
The guidelines for CD4>200 and ASYMPTOMATIC patients are not CLEAR! AS YET!
the decisions are based on
- prognosis as determined by CD4 and Viral load
- Willingness of patient to adhere to therapy
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