Starting anti-HIV drugs when T-cell counts are above 350 does not result in better immune system recovery as measured through increases in T cells, unless the treatment is begun within one year of infection, according to a study in the March edition of the Journal of Acquired Immune Deficiency Syndromes. An analysis of 20 HIV studies showed that patients who started antiretroviral drugs when their T-cell counts were above 350 posted no better gains in immune cell restoration than patients who started the drugs with T-cell counts between 201 and 350. The average T-cell rebound in both groups was 119 cells. The best results were seen in patients who began the anti-HIV drugs less than one year after infection. The worst rebounds were observed in patients who had fewer than 200 T cells at the time of treatment initiation.
The study authors conclude that there is no advantage to starting antiretroviral treatment when patients have 350 or more T cells. Current U.S. treatment guidelines call for anti-HIV drugs to begin when T-cell counts fall below 350, but European guidelines are more conservative and say that most patients can wait until their T-cell levels fall to between 200 and 350.