Question
How long will it take until I need treatment?
14 February 2013. Related: All topics, CD4 and viral load, Starting treatment.
Hi
I know I was recently infected because I had seroconversion symptoms two weeks after a risk exposure in December and I had a negative HIV test a few months before that in September. I am reading about treatment for when I need it, but I hoped this wouldn’t be for several years. Is this true? How quickly to people start treatment and how long until I need to be thinking about this?
Answer
Hi
I’m sorry about your recent diagnosis. It is good that you are finding out about information as this will help you feel more in control at what is still likely to be a difficult time. How are you doing?
Thanks for your question though which is important, though the answer involves several different things.
Firstly, although we have information about average times, there are a very wide range of responses. The time for you as an individual could be anywhere in this range. You will only be able to build a picture of how your well your body is fighting HIV by looking at the results from blood tests over the next few months.
The most important test is your CD4 count. This is a marker for immune health in relation to HIV. The second most important is viral load. This gives an idea of how well your body is controlling the virus. Taken together, these tests are used to decide when to start treatment in the UK. Other factors are also important though including your general health, guidelines for where you live, and when and whether you want to start treatment.
Current UK guidelines recommend starting treatment when the CD4 count is around 350, although there are some circumstances for starting earlier.
The average time that CD4 cells take to reach 350 has been estimated from a European study of over 18,000 people similar to you, who were diagnosed in early infection. This study was mainly men (78%) and average age was about 30 when they were diagnosed. [1]
The average CD4 count one year after infection was 510 – but 25% of people were already under 350 and 25% of people were still higher than 720. After two years, the average CD4 count was 460: but 25% of people were now less than 300 and 25% higher than 650.
The average time for the CD4 count to reach 350 was just over four years. However, the range might mean that for you this might be two years or ten years. Other important factors include age and gender.
Also, guidelines are different. Some countries have guidelines to start treatment earlier at a higher CD4 count of 500. Using this threshold, the study estimated about 50% of people would need to start treatment within one year of infection.
This can be confusing. These guidelines are all written by experts who interpret the same studies but come to different conclusions. This is because the absolute risk of anything serious happening due to HIV while your CD4 count is higher than 350 is very low. At even higher CD4 counts, the risks become lower still and very large studies are needed to see differences. [2]
A few countries, mainly the US, have guidelines that recommend treatment at any CD4 count, even when this is much higher than 500, and even in early infection. This is partly because being on treatment makes you less infectious to sexual partners.
If you are interested in using treatment to reduce your level of infectiousness, UK guidelines include the option to start treatment at any CD4 count. [3]
Reference
- Lodi S and colleagues. Time From Human Immunodeficiency Virus Seroconversion to Reaching CD41 Cell Count Thresholds ,200, ,350, and ,500 Cells/mm3: Assessment of Need Following Changes in Treatment Guidelines. Clinical Infectious Diseases. Clin Infect Dis. (2011) 53 (8): pages 817-825.
http://cid.oxfordjournals.org/content/53/8/817.abstract (online summary)
http://cid.oxfordjournals.org/content/53/8/817.full.pdf (PDF file) - The START study is enrolling more than 4000 people with CD4 counts higher than 500 to look at both the risks and benefits for earlier treatment.
https://i-base.info/start-study/ - British HIV Association (BHIVA). Treatment of HIV-1 positive adults with antiretroviral therapy (2012). Available free online.
http://www.bhiva.org/TreatmentofHIV1_2012.aspx
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