European treatment guidelines advise below 350 start

New European guidelines on the use of antiretroviral therapy were unveiled in Athens today at the opening of the 8th European Conference on Clinical Aspects and Treatment of HIV Infection. Devised by the European AIDS Clinical Society (EACS), these guidelines are the first document of this kind developed by a Europe-wide body.

The EACS guidelines reflect the ongoing debate over the optimal timing of anti-HIV therapy. Whilst newly released guidelines from the British HIV Association (BHIVA), (available on aidsmap via the homepage), advocate a later start point than previously recommended - before the CD4 reaches 200 - EACS have fallen in line with this year's US Federal guidelines, urging that therapy should begin when the CD4 count falls below 350. This point appears to be a compromise between polarised views within the EACS panel; 'HAART hawks' are understood to have pushed for treatment to be recommended at CD4 counts below 500, while more moderate members argued for a cut-off more in line with BHIVA's.

At CD4 counts above 350, a clinical situation which does not merit intervention according to BHIVA, EACS say that treatment should be considered in those whose viral load is between 50,000 and 100,000 copies. A viral load above 100,000 would warrant treatment regardless of CD4 level, according to EACS.

Choice of first-line therapy is not specified by EACS, though this position is qualified by the recommendation that PI-based HAART be used in people who begin treatment with high viral load (above 100,000 copies), and by women who begin treatment during pregnancy.

The EACS recommendations were developed during a symposium for European clinicians, virologists and immunologists in May of this year. The full guidelines will be published on the EACS website shortly, and summarised in a future issue of AIDS.