Initiation of antiretroviral therapy at CD4 cell counts >/=350 cells/mm3 does not increase incidence or risk of peripheral neuropathy, anemia, or renal insufficiency.
BACKGROUND
US guidelines recommend deferring initiation of highly active antiretroviral therapy (HAART) for most patients with CD4 counts >350 cells/mm in part because of concerns about antiretroviral toxicity.


METHODS
Incidence rates of peripheral neuropathy, anemia, and renal insufficiency in a cohort of 2165 patients followed more than 3 years (mean) were analyzed in multivariate Cox proportional hazards models by CD4 cell counts at initiation of HAART. A nested cohort of 895 patients restricted to study participants who did or did not start HAART within a CD4 cell count stratum were also compared.


RESULTS
Incidence and risks of all 3 comorbidities decreased with initiation of HAART at CD4 counts >200 cells/mm versus <200 cells/mm. Incidence and risks of renal insufficiency were similar with HAART initiation at CD4 counts >/=350 cells/mm versus 200 to 349 cells/mm, but risk of peripheral neuropathy and anemia were further decreased in persons starting HAART at a CD4 count >/=350 cells/mm. The incidence of these conditions was highest during the first 6 months of treatment at any CD4 cell count and declined up to 19-fold with further therapy.


CONCLUSIONS
Initiating HAART at CD4 cell counts >/=200 cells/mm reduced the incidence and risk of the 3 comorbid conditions and for anemia and peripheral neuropathy as well by starting at CD4 counts >/=350 cells/mm. The incidence of each condition decreased rapidly and remained low with increasing time on HAART.
Lichtenstein
Kenneth A
KA
University of Colorado Health Sciences Center, Denver, CO, USA. lichtensteink@njc.org
Armon
Carl
C
Buchacz
Kate
K
Chmiel
Joan S
JS
Moorman
Anne C
AC
Wood
Kathleen C
KC
Holmberg
Scott D
SD
Brooks
John T
JT
D000328:Adult; D000740:Anemia / Q000139:chemically induced / Q000453:epidemiology*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced / Q000453:epidemiology*; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000139:chemically induced / Q000453:epidemiology*