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If We Can't Get What We Want, Can We Get What We Need? Optimizing Use of Antiretroviral Therapy in the Current Era

Jason V. Baker, MD, MS; and Keith Henry, MD
[+] Article, Author, and Disclosure Information

From University of Minnesota School of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0561.

Requests for Single Reprints: Keith Henry, MD, HIV Program, Hennepin County Medical Center, 701 Park Avenue, MC O1, Minneapolis, MN 55415; e-mail, keithh6680@aol.com.

Current Author Addresses: Drs. Baker and Henry: HIV Program, Hennepin County Medical Center, 701 Park Avenue, MC O1, Minneapolis, MN 55415.

Ann Intern Med. 2011;154(8):563-565. doi:10.7326/0003-4819-154-8-201104190-00009
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The study by the HIV-CAUSAL Collaboration in this issue addresses the optimal time to initiate cART. The editorialists discuss the findings and limitations of this and other cohort studies. They conclude that the HIV-CAUSAL Collaboration study supports the presence of a graded benefit of cART even when risk for AIDS is low. They emphasize, however, that uncertainty remains regarding the cumulative benefits of treating everyone who has HIV infection.

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Cumulative HIV-related disease risk, by CD4 cell count.

A schematic interpretation of the benefits of initiating cART to reduce individual health risk on the basis of CD4 cell count. Initiating cART at higher versus lower CD4 cell count thresholds may result in a much smaller absolute benefit, as indicated by the slope of curve. A strategy of initiating cART earlier and at higher CD4 cell counts, with the ultimate goal of identifying and treating everyone, will eventually outpace available resources. cART = combination antiretroviral therapy.

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