Using treatment at higher CD4 counts: the START trial
A large international study called START is looking at whether it may be better to start even earlier – when your CD4 count is above 500 cells/mm3.
This is likely to be the most important study in the next five years. No other randomised trial has answered this question.
If your CD4 count is still over 500 and you are interested in earlier treatment, talk to your doctor about in this study.
The use of earlier treatment is due to three main factors:
- Treatment reduces the risk of less common but serious illnesses, even at relatively high CD4 counts.
- Drugs used in most Western countries are now more tolerable. They have fewer side effects and require fewer daily pills and doses.
- Your CD4 response to treatment is related to the lowest level before your start (called the CD4 nadir). By starting treatment at a higher CD4 count, you keep more of your immune system. This increases the chance of reaching ‘normal levels (over 500 cells/mm3). See CD4 response rate.
However, there are benefits and risks from both earlier treatment and from delaying treatment. This is why we need information from the study.