title: Initiation of antiretroviral therapy at CD4 cell counts >/=350 cells/mm3 does not increase incidence or risk of peripheral neuropathy, anemia, or renal insufficiency.
abstract: 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.
authors.affiliation: University of Colorado Health Sciences Center, Denver, CO, USA. lichtensteink@njc.org
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Lichtenstein
authors.forename: Carl
authors.initials: C
authors.lastname: Armon
authors.forename: Kate
authors.initials: K
authors.lastname: Buchacz
authors.forename: Joan S
authors.initials: JS
authors.lastname: Chmiel
authors.forename: Anne C
authors.initials: AC
authors.lastname: Moorman
authors.forename: Kathleen C
authors.initials: KC
authors.lastname: Wood
authors.forename: Scott D
authors.initials: SD
authors.lastname: Holmberg
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
mesh_terms: 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*