More people in the UK are starting HIV treatment early, in order to reduce their risk of transmission

Roger Pebody
Original Article:

There is evidence of increasing interest in HIV treatment as prevention among people living with HIV in the UK, with the number of people starting treatment at high CD4 cell counts doubling over a five-year period, according to data presented at a Public Health England meeting this week. In 2013, 49% of those starting treatment had a CD4 count of more than 350 cells/mm3, including 27% with more than 500 cells/mm3.

Whereas some international guidelines recommend beginning HIV treatment at a CD4 cell count of 500 cells/mm3 or earlier, the authors of the UK guidelines do not believe that there is clear evidence that this will lead to improved individual health outcomes. In general, the UK guidelines recommend that treatment is begun with a CD4 count of around 350 cells/mm3.

However, treatment at a higher CD4 count is recommended if an individual has a co-morbidity such as hepatitis B, hepatitis C, tuberculosis, HIV-related kidney disease or HIV-related neurocognitive illness. Pregnant women should also take HIV treatment, whatever their CD4 count.

Moreover, since 2012, the UK guidelines have also recommended that doctors should discuss the evidence for the effectiveness of antiretroviral treatment as prevention with all patients with HIV. Regardless of CD4 cell count, any individual who wishes to take treatment in order to protect their partners from the risk of HIV infection should be able to do so.

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