A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

A Guide to Primary Care of People with HIV/AIDS
Chapter 5: Antiretroviral Therapy
5
Agents in HIV-Infected Adults and Adolescents (available
at http://www.aidsinfo.nih.gov) the CD4 cell count range
of 200-350/mm 3 is also an indication for ART, but the
decision is tempered by the viral load, the rapidity of
the CD4 cell count decline (CD4 cell slope), and patient
readiness. The role of viral load in this decision is based
on 2 observations: 1) the viral load is an independent
predictor of progression and 2) the CD4 decline slope
is directly correlated with viral load. The implication
is that a high viral load imparts a risk for more rapid
progression to AIDS and a more rapid decline in the
CD4 cell count. The threshold that appears important
in the CD4 cell strata of 200-350 is ≥20,000 copies of
virus/mL (c/mL). Some authorities also treat patients
with a viral load of 50,000-100,000 c/mL even when the
CD4 cell count is >350/mm 3 , but there is no consensus
here. It should be emphasized that multiple cohort
studies involving thousands of patients clearly indicate
that therapy is necessary when the CD4 cell count is
350/mm 3
and a viral load of 350/mm 3 Defer therapy Some authorities
treat if viral load is
>55,000 c/mL
CD4 cell
count of 200-
350/mm 3 Treat or defer therapy Influencing factors
include
• Patient
readiness
• CD4 slope
(rate of
decline)
• Viral load
(