Here’s another interesting tidbit from the closed journal AIDS that leaves big holes in current AIDS drug treatment guidelines.
For starters, this study was not a small one. Researchers followed 9,406 patients (majority white males) and compared the likelihood of adverse drug effects, depending on their CD4 count at the time they initiated ARV (antiretroviral drug) treatment. It followed patients who started treatment over a decade (though how long individual patients were tracked is not included in the abstract).
Each patient fell into one of three groups: <350 CD4 cells/muL; 351-499; and >500. This last group would be considered “normal” according to AIDS.gov, which lists the range for CD4 counts as 500-1000. Yet, according to this study, this group of so-called “healthy” patients were almost one and a half times more likely to experience a drug-related adverse effect.
The report reinforces another point that I find I must continue to drive home over and over again, and that is the definition of “low CD4 counts”. By now, most AIDS research is tacitly defining that term as <350. It is not clear how the threshold for risk of opportunistic infections got moved from <200 to 350, but that is implication today. As flaky as these numbers can be, I continue to observe that most Affecteds who are not on ART and who are hospitalized with a serious infection, or who die, have extremely low (defined as single- or low double-digit) CD4 counts.
To reiterate: all groups experienced adverse drug effects, regardless of their CD4 counts at initiation, but those with normal levels experienced these problems more often. Despite this evidence, the latest message from the official AIDS Treatment Guidelines is that everyone testing HIV-positive should be put on the drugs, and even some “at risk” individuals who don’t even test HIV-positive.
It doesn’t take a genius to figure out that by starting treatment early, a patient is expected to be on these drugs for a longer period of time, and that the cumulative risk of adverse effects goes up.
Like far too much of the AIDS research that is published in peer-reviewed journals like AIDS, the details of this study (what kinds of adverse effects were reported, for example) is lock away from public view behind an exorbitant subscription ($818/year).