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START sub-studies show no differences in lung or neurocognitive function with early or later treatment
Liz Highleyman, 2015-10-27 18:00:00

Participants who started antiretroviral therapy (ART) soon after HIV diagnosis in the large START trial showed no differences in lung function or neuropsychological performance when compared to people randomised to deferred ART, according to two studies presented last week at the 15th European AIDS Conference in Barcelona, Spain.

A related study found that earlier initiation of treatment in the START trial was associated with greater bone loss over time.

Starting antiretroviral treatment before the development of serious immune system damage greatly reduces the risk of HIV disease progression and death, but early treatment can potentially also have drawbacks including longer exposure to toxic drugs. The INSIGHT START (Strategic Timing of Antiretroviral Treatment) trial was designed to address the long-standing controversy over the optimal timing of HIV treatment, especially for people who still have high CD4 counts.

The primary START results, presented this summer at the International AIDS Society Conference in Vancouver and published in the August 27 New England Journal of Medicine, showed that participants randomised to start ART soon after HIV diagnosis had a significantly lower risk of illness and death than those who waited. The immediate treatment group not only had a 72% lower risk of AIDS-related infections and malignancies compared to the deferred group, but also were 39% less likely to experience serious non-AIDS events (heart, liver and kidney events and non-AIDS cancers) or death.

The START design included several sub-studies looking at the effects of early versus deferred therapy on specific outcomes known or suspected to be associated with HIV infection or its treatment, including bone density, lung function and neurocognitive function.

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