HIV treatment – starting treatment
The finding looks set to further fuel the debate about the best time to start HIV treatment. Current UK guidelines recommend treatment at a CD4 cell count of around 350, but some doctors think there would be advantages if treatment were started earlier. A big international study is currently underway to try to establish if there are any advantages to starting HIV treatment earlier than is currently recommended.
It is already known that HIV can cause inflammation – a process that increases the risk of serious illnesses. However, little is known about the impact of uncontrolled HIV replication on the health of people with higher CD4 cell counts.
Therefore European researchers looked at the medical records of approximately 11,500 people.
They were divided according to the level of their viral load. Most (82%) had a low viral load (below 500 copies/ml); 11% had an intermediate viral load, between 500 and 10,000 copies/ml, and 9% had a high viral load, defined as being above 10,000 copies/ml.
Patients who had an intermediate or high viral load were much more likely than those with a low viral load to develop a serious HIV-related illness.
There was also some evidence that having a viral load above 500 copies/ml was associated with an increased risk of developing a non-HIV-related illness such as cardiovascular disease.
For more information on viral load and CD4, you may find our booklet CD4, viral load and other tests helpful.
HIV care – missed appointments
With the right treatment and care many people with HIV will have a near-normal life expectancy.
It’s important to attend an HIV clinic for regular check-ups so that the impact of HIV on your health can be monitored, enabling you to start treatment promptly.
HIV treatment needs to be taken correctly, and the best outcomes are seen in people who take all, or nearly all, of their doses at the right time and in the right way. This is often referred to as adherence.
US researchers monitored approximately 700 people to see if missed appointments in the first two years after their entry into HIV care was associated with poorer control of HIV once they started antiretroviral therapy.
Just over three-quarters of patients started HIV therapy, and 66% achieved an undetectable viral load an average of 300 days after initiating treatment.
They found that each missed appointment soon after HIV diagnosis reduced the chances of achieving an undetectable viral load by about 17%.
In addition, missed appointments were also associated with having a higher total, or cumulative viral load in the period after therapy was started.
These findings were unaltered when the researchers restricted their analysis to patients who had a CD4 cell count above 350 at the time they entered care.
The researchers think that people who missed appointments are less likely to have the high levels of adherence needed for HIV treatment to work.
A lot of help is available if you are having difficulty taking your HIV treatment. It’s a good idea to discuss any problems with your HIV doctor, or someone else in your healthcare team.
A good place to find more information is our booklet, Adherence & resistance.