title: CD4+ T cell counts in initiation of antiretroviral therapy in HIV infected asymptomatic individuals; controversies and inconsistencies.
abstract: The primary goal when devising strategies to define the start of therapy in HIV infected individuals is to avoid HIV disease progression and toxicity from antiretroviral therapy (ART). Intermediate goals includes, avoiding resistance by suppressing HIV replication, reducing transmission, limiting spread and diversity of HIV within the body and protecting the immune system from harm. The question of how early or late to start ART and achieve both primary and intermediate goals has dominated HIV research. The distinction between early and late treatment of HIV infection is currently a matter of CD4+ T cells count, a marker of immune status, rather than on viral load, a marker of virus replication. Discussions about respective benefits of early or delayed therapy, as well as the best CD4+ T cell threshold during the course of HIV infection at which ART is initiated remains inconclusive. Guidelines issued by various agencies, provide different initiation recommendations. This can be confusing for clinicians and policy-makers when determining the best time to initiate therapy. Optimizing ART initiation strategies are clearly complex and must be balanced between individual and broader public health needs. This review assesses available data that contributes to the debate on optimal time to initiate therapy in HIV-infected asymptomatic individuals. We also review reports on CD4+ T cell threshold to guide initiation of ART and finally discuss arguments for and against early or late initiation of ART.
authors.affiliation: Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Ghana; Centre for Microbiology Research, Kenya Medical Research Institute, Kenya. Electronic address: emaina02@yahoo.com.
authors.forename: E K
authors.initials: EK
authors.lastname: Maina
authors.affiliation: Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Ghana.
authors.forename: E Y
authors.initials: EY
authors.lastname: Bonney
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute, Kenya.
authors.forename: E A
authors.initials: EA
authors.lastname: Bukusi
authors.affiliation: Malaria Program, Naval Medical Research Centre, USA.
authors.forename: M
authors.initials: M
authors.lastname: Sedegah
authors.affiliation: Department of Medicine, School of Medicine & Dentistry, CHS, University of Ghana, Ghana.
authors.forename: M
authors.initials: M
authors.lastname: Lartey
authors.affiliation: Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Ghana.
authors.forename: W K
authors.initials: WK
authors.lastname: Ampofo
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005060:Europe; D006678:HIV / Q000187:drug effects* / Q000276:immunology / Q000502:physiology; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D017410:Practice Guidelines as Topic; D013997:Time Factors; D014481:United States; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS; Antiretroviral therapy; CD4+ T cell; HIV