A group of HIV experts believes there is not yet enough evidence to support a recommendation of universal antiretroviral treatment regardless of CD4 levels, aidsmap reports. Publishing their argument in the journal AIDS, a group of researchers from the United Kingdom, Australia and Brazil have critiqued various inconsistencies in several global bodies' policies on when people with HIV should start treatment. The scientists reason that if these organizations used more exacting standards to rate the evidence on when to start treatment their recommendations would prove more in line with one another's.

The guidelines discussed in the article include those of the United States Department of Health and Human Services, The International Antiviral Society USA, The World Health Organization (which recently recommended all people with HIV begin ARVs at 500 or fewer CD4s), the European AIDS Clinical Society and The British HIV Association.

The paper's authors point out that there are no published results from a randomized controlled trial (RCT)—the gold standard of scientific research—that assess the risks and benefits of beginning treatment before CD4s hit 350. Among the four available observational cohort studies (which produce a less sterling form of scientific proof) addressing this concern, just two showed a higher death rate among those starting therapy after the 350 benchmark. Only one study showed a benefit of beginning therapy before CD4s drop below 500.

There are, however, two RCTs currently examining the difference of beginning therapy before or after CD4s fall below 350, with results expected in 2014 and 2016.

To read the aidsmap story, click here.

To read the AIDS article abstract, click here.