Initiation of antiretroviral therapy at CD4 cell counts ≥350 cells/mm3 does not increase incidence or risk of peripheral neuropathy, anemia, or renal insufficiency

Kenneth A. Lichtenstein, Carl Armon, Kate Buchacz, Joan S. Chmiel, Anne C. Moorman, Kathleen C. Wood, Scott D. Holmberg, John T. Brooks

Research output: Contribution to journalArticlepeer-review

65 Scopus citations


BACKGROUND: US guidelines recommend deferring initiation of highly active antiretroviral therapy (HAART) for most patients with CD4 counts >350 cells/mm in part because of concerns about antiretroviral toxicity. METHODS: Incidence rates of peripheral neuropathy, anemia, and renal insufficiency in a cohort of 2165 patients followed more than 3 years (mean) were analyzed in multivariate Cox proportional hazards models by CD4 cell counts at initiation of HAART. A nested cohort of 895 patients restricted to study participants who did or did not start HAART within a CD4 cell count stratum were also compared. RESULTS: Incidence and risks of all 3 comorbidities decreased with initiation of HAART at CD4 counts >200 cells/mm versus <200 cells/mm. Incidence and risks of renal insufficiency were similar with HAART initiation at CD4 counts ≥350 cells/mm versus 200 to 349 cells/mm, but risk of peripheral neuropathy and anemia were further decreased in persons starting HAART at a CD4 count ≥350 cells/mm. The incidence of these conditions was highest during the first 6 months of treatment at any CD4 cell count and declined up to 19-fold with further therapy. DISCUSSION: Initiating HAART at CD4 cell counts ≥200 cells/mm reduced the incidence and risk of the 3 comorbid conditions and for anemia and peripheral neuropathy as well by starting at CD4 counts ≥350 cells/mm. The incidence of each condition decreased rapidly and remained low with increasing time on HAART.

Original languageEnglish (US)
Pages (from-to)27-35
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number1
StatePublished - Jan 2008


  • Anemia
  • Highly active antiretroviral therapy
  • Peripheral neuropathy
  • Renal insufficiency

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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