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START trial provides definitive evidence of the benefits of early HIV treatment
Liz Highleyman, 2015-07-21 11:30:00
People who start antiretroviral therapy (ART) immediately after HIV diagnosis, while their CD4 cell count is still high, rather than waiting until it falls below 350 cells/mm3 have a significantly lower risk of illness and death, according to long-awaited findings from the START trial. The final study results were presented on Monday at the Eighth International AIDS Society Conference (IAS 2015) in Vancouver, Canada, and published simultaneously in the July 20 advance edition of the New England Journal of Medicine.
Professor Jens Lundgren of the University of Copenhagen reported that 1.8% of study participants in the immediate treatment group experienced a combined endpoint of serious AIDS-related events, serious non-AIDS events and death, compared with 4.1% in the deferred therapy group – a 57% reduction. The most common events in both arms were tuberculosis (TB) and cancer.
These findings suggest that HIV causes persistent immune system damage soon after infection, and "clearly indicate that ART should be provided for everyone regardless of CD4 count," Lundgren told aidsmap.com.
[The findings] "clearly indicate that ART should be provided for everyone regardless of CD4 count." Jens Lundgren
It is well known that starting ART before CD4 cell counts fall to low levels dramatically reduces the frequency of opportunistic illness and improves survival. A growing body of evidence shows that earlier treatment is associated with decreased disease progression and death, as well as minimising the risk of onward transmission of HIV.
But very early HIV treatment can have drawbacks, too, including longer exposure to potentially toxic therapy. In addition, some early treatment critics have expressed concern that people with HIV could be pressured to start treatment before they are ready, to benefit others rather than their own health
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