Top 10 HIV Clinical Developments of 2008 - CD8 T cells - The Body

12 • HIV JournalView—Top 10 HIV Clinical Developments of 2008
inclined to fall on the more aggressive side in offering HIV
treatment to willing patients with CD4+ cell counts in the
netherworld of 350 to 500 cells/mm 3 —the NA-ACCORD
findings are validating and in time may inspire treatment
at even higher CD4+ cell counts, especially given recent
concerns regarding the relationship between HIV viremia
and inflammation, which brings us to the second top story
of 2008. ª
Study Snapshot: When to Start HIV Therapy (NA-ACCORD Study)
Design: Observational cohort study of HIV-infected patients in Canada and the United States.
Population: Over 8,300 HIV-infected patients with CD4+ cell counts between 351 to 500 cells/mm 3 .
Main Results: Starting HIV therapy at a CD4+ cell count greater than 350 cells/mm 3 was associated with a 70%
improvement in survival (RH: 1.7; 95% CI, 1.4-2.1; P < .001)—an effect that persisted even after adjusting for factors
associated with impaired survival (e.g., injection drug use, HCV coinfection).
Significance: Indicates that a starting threshold for HIV therapy of 350 cells/mm 3 is too low and, more importantly, that
deaths can be prevented with earlier initiation of HIV therapy.