Hit HIV-1 hard, but only when necessary

After four years of widespread highly active antiretroviral therapy (HAART), questions about the cocktail’s use continue. Clinicians and activists debate when is the best time to start HAART, how therapy failure should be treated, and how to best fight drug resistance. Studies show that HAART can benefit people with CD4 cell counts under 350.

In a World AIDS commentary in The Lancet, Mark Harrington, of the Treatment Action Group in New York, and Charles C.J. Carpenter, of Brown University School of Medicine, Miriam Hospital in Providence, suggest that clinically relevant immune system damage and progression to AIDS and death can be significantly delayed or prevented with careful monitoring of CD4 cell levels and viral loads and when HAART is generally started when the CD4 cell count drops under 350.

They note there is currently no available regimen to eliminate HIV-1; all the existing treatments can cause toxic effects; and multidrug resistance can develop unless treatment regimens are followed very closely. ‘Since the long-term adverse consequences of currently available antiretroviral therapy have become clearer, [it] is important to further define when, in the course of HIV-1 infection, these are outweighed by the proven benefits of antiretroviral therapy,’ the authors conclude.