New treatment guidelines for HIV patients suggest drug treatment can be delayed

CHICAGO (AP) -- New treatment guidelines suggest symptom-free HIV patients can wait longer than previously recommended to begin taking AIDS drugs.

"The threshold for initiation of therapy has shifted to a later time in the course of HIV disease" because of increased awareness of the effectiveness of AIDS drugs and their toxic side effects, an International AIDS Society-USA panel concluded.

In the mid-1990s, when a new class of drugs helped transform HIV into a manageable chronic disease for many patients, doctors often started treatment immediately in people who were newly infected.

Guidelines have since eased amid mounting evidence that it's safe to wait.

The new guidelines appear in the July 10 issue of the Journal of the American Medical Association but were released early to coincide with the International AIDS Conference in Barcelona, Spain.

The panel recommends starting drug treatment when levels of disease-fighting CD4 white blood cells drop to between 200 and 350 per cubic millimeter.

The group two years ago suggested treatment with CD4 levels of about 350. A U.S. Health and Human Services group of experts issued similar guidelines in January 2001.

The drugs may be beneficial in some patients with higher counts, but the risks in such patients generally outweigh the benefits, the guidelines say.

Patients generally must take three or more drugs at a time, in combinations that must be switched often to combat drug resistance. The drugs also can have serious side effects like increased cholesterol levels and disfiguring body-fat changes.