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When to Start ART?

Older HIV+ People May Benefit from Earlier ART

Starting antiretroviral treatment at higher CD4 T-cell counts predicted better long-term immune recovery in a large U.S. cohort, while age over 50 years and hepatitis B or C coinfection were linked to smaller CD4 cell gains.

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HIV Treatment Dramatically Reduces Sexual Transmission

Early antiretroviral therapy (ART) decreased the likelihood of HIV transmission between heterosexual partners by 96% in the large international HPTN 052 trial.

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Earlier HIV Treatment Is More Cost Effective

Testing and treating people with HIV early in the course of disease is more cost-effective than waiting until they develop serious immune deficiency, according to study findings published in the December 2010 issue of Medical Care. Late care remains common, however -- people who accessed care after their CD4 count had fallen to 200 cells/mm3 (the criteria for AIDS) accounted for more than 40% of patients treated at urban centers over the past decade.

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More Evidence for Starting ART at 500 CD4 Cells

Starting antiretroviral treatment when CD4 count falls below 500 cells/mm3 reduces the risk of AIDS-defining illness -- but not death -- compared with a 350 cells/mm3 threshold.

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Early Antiretroviral Treatment Can Help Preserve B-Cell Immune Function

People with HIV have lower levels of antibody-producing B-cells than HIV negative individuals, but numbers rise significantly after initiation of effective antiretroviral therapy (ART), according to a study published in the September 13, 2010 advance online edition of Blood. What's more, people at an early stage of HIV infection had more fresh B-cells and achieved full recovery, while those with chronic infection had more immature or exhausted cells and did not reach normal levels, suggesting it may be beneficial to start ART sooner, while B-cell immune function is still relatively well preserved.

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