The British HIV Association (BHIVA) has published the latest draft of its Treatment Guidelines including a recommendation that everyone should receive treatment regardless of CD4 count.
Out to consultation this week, the new draft guidelines recommend that anyone living with HIV that is ready to start treatment, and understands that it is a life long commitment, should be offered treatment. Previous guidelines recommended that treatment was started when a person’s CD4 count fell below 350, these new guidelines essentially remove that requirement. The guidelines also recognise that it’s important for the patient to feel ready to start treatment, as those who start before they are comfortable often have issues with adherence.
The changes are due, in part, to the recent data from the START trial. The data, released at the end of May this year, showed that those starting treatment with a CD4 count above 500 had the risk of death and other serious complications reduced by 53% when compared to those who started treatment once their CD4 count had fallen below 350.
Also new in the draft guidelines is a recommendation that those who are diagnosed early, within 12 twelve weeks of their infection, should be encouraged to commence treatment straight away. Those starting treatment in the early stages of ‘primary infection’ can limit the size of the viral reservoirs, reduce their infectiousness at a time when their VL will be at its highest, and potentially have a higher long-term CD4 count.
The draft guidelines are open for consultation until Friday 17th July 2015.