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.

This is likely to be a very important study. 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 this study.

Advantages of earlier treatment include:

• Treatment reduces the risk of some 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.
• By starting treatment at a higher CD4 count, you keep more of your immune system. This increases the chance of reaching or keeping ‘normal’ levels (CD4 over 500). See CD4 response rate.
• Treatment will make you less infectious to sexual partners.

There are potential benefits and risks from both earlier treatment and from delaying treatment. This is why we need this study.