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BACKGROUND: There have been concerns that irreversible immune damage may result if highly active antiretroviral therapy (HAART) is initiated after the CD4 cell count declines to below 350 cells/microL; however, the role of antiretroviral adherence on CD4 cell count responses has not been well evaluated. METHODS: We evaluated CD4 cell count responses of 1522 antiretroviral-naive patients initiating HAART who were stratified by baseline CD4 cell count (or=200 cells/microL) and adherence. RESULTS: Among patients starting HAART with or=50 cells/microL from baseline (relative hazard RH = 2.88, 95% confidence interval CI: 2.46-3.37). Among patients with baseline CD4 cell counts 200 cells/microL (RH = 4.85, 95% CI: 3.15-7.47). CONCLUSIONS: These data demonstrate that substantial CD4 gains are possible among highly advanced adherent patients and should contribute to the ongoing debate over the optimal time to initiate HAART.
Wood et al. (Mon,) studied this question.
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