As we have reported several times over the past year, there is now conclusive evidence that it is better to start HIV treatment sooner, rather than later. This applies to all people living with HIV.
This was proven in a large study, called START, whose main findings were reported last summer. Everyone who took part had a high CD4 cell count, above 500, when they entered the study.
START showed that by beginning HIV treatment early people living with HIV can significantly reduce their risk of developing AIDS, other serious illnesses unrelated to AIDS, or dying.
The benefit was seen in men and women, in people of all ages, in all regions of the world, and in people with different medical histories. In all subgroups, people with HIV who began treatment immediately did better than people who waited.
Nonetheless, a new analysis from the study has shown that there were some subgroups in which the benefit was especially pronounced. They found that starting treatment without delay is especially important for:
- People over the age of 50.
- People with a very high viral load, above 50,000 copies/ml.
- People with a low CD4/CD8 ratio.
- People who have a high risk of developing heart disease.
Prompt treatment was especially likely to prevent illnesses in individuals in these groups.
These findings could be important if you have chosen not to start HIV treatment for the moment. They could help you and your doctor assess how safe it is to continue without treatment.
The CD4/CD8 ratio is probably not familiar to many readers. CD4 cells and CD8 cells are two different types of cells in the immune system. The ratio is an indication of how balanced your immune function is.
HIV-negative people typically have a ratio of 1 (meaning that there are as many CD8 cells as CD4 cells) or above.
People living with HIV may have a lower ratio. A ratio of 0.5 shows that there are half the number of CD4 cells as CD8 cells. In this study, people with ratios below this level were more likely to get ill if they did not take HIV treatment. Their results improved when they began HIV treatment.
The researchers found that CD4/CD8 ratios gave more useful information than CD4 counts on their own.