Peripheral neuropathy, anemia and kidney problems are common occurrences in people with HIV, notably those on antiretroviral (ARV) treatment. In turn, some experts have suggested that starting treatment earlier than is currently recommended—a CD4 count below 350 cells—may result in an upswing in these complications among otherwise healthy people living with the virus.

The HOPS investigators, under the direction of Kenneth Lichtenstein, MD, of the University of Colorado in Denver followed 2,165 HIV-positive patients who started ARV treatment with varying CD4 counts for approximately three years.  Patients were divided into three groups: those who started with CD4s below 200, between 200 and 349, and 350 or higher.

Among patients starting therapy with CD4s above  200, the number of new cases (incidence) of peripheral neuropathy, anemia and kidney problems—and the risk for these complications—was lower, compared with those starting HIV treatment with CD4s below 200. The incidence and risks of kidney problems were similar among those starting therapy with CD4s above 350 versus 200 to 349, but the risk of peripheral neuropathy and anemia was found to be lower among those starting with 350 or more CD4s.

Dr. Lichtenstein’s group also reported that the incidence of each condition decreased rapidly and remained low the longer patients remained on ARV therapy. The risk of these complications occurring was actually highest during the first three months of treatment, regardless of the pre-therapy CD4 count.