Why should we wait till the CD-4 count down to below 200?

[Guest guest]

Dear Forum,

This is in response to Mr. K. Reddy,'s query seeking information about CD-4

count and his question " why should we wait till the CD-4 count down to below

200? "

What Mr. Reddy want to know is an important question. As HIV appeared as a new

disease followed by the research and the new drugs, it was realized by the

doctors that ‘Hit early, hit hard’ as advocated by Ho in 1995 is not the

right strategy. There were following problems to that strategy—

However early you start the ART, some of the virus will always get hidden in the

resting (latently infected) CD-4 cells and will not get killed by the drugs you

use. and ultimately lead the patient to drug resistance, failure of therapy and

death.

The drugs used have long term ( as well as short term) toxicities. so the later

we start the better it is. Patients fail to adhere to the strict prescribed

regimen as the therapy is life long. So later, the better.

So now, Hit only when needed is the right approach.

Multiple studies have proven that there is a strong association between the

baseline CD-4 level and the probability of progression to AIDS / death: i.e.

CD4 50-99 cells/ cmm - 74% chance

CD4 100-199 -52%

CD4 200-349 -24%

CD4 > 350 - 18% or less

So we can conclude that this last weapon of ART should be well reserved till the

CD4 count does not fall to 200 when there is a substantially high chance of

patient developing AIDS.

With regards,

Dr. Divya Mithel,

Jyothis Care center, Kalamboli

e-mail: <d_mithel@...>