Starting antiretroviral therapy (ART) early in HIV infection when the immune system is stronger leads to better long-term health outcomes than delaying antiretroviral therapy, according to findings presented today at the IDWeek conference in Washington, DC.
The results are based on an extensive follow-up of participants in the START (strategic timing of antiretroviral therapy) study funded by the National Institutes of Health. In 2015, START showed a 57% reduced risk of developing AIDS and serious health problems unrelated to AIDS among participants who started antiretroviral therapy when their CD4+ T-cell count – a key indicator of immune system health – was above 500 cells per year. Once. cubic millimeters (mm³) compared to those who started ART only when their CD4+ count fell below 350 cells/mm3 or they developed AIDS. Following a 2015 report on these findings, participants in the delayed treatment group were advised to start ART.
About 1.2 million people in the United States are living with HIV and about 13% are unaware they have it, according to the Centers for Disease Control and Prevention. When HIV diagnosis and treatment are delayed, HIV continues to multiply. This can have a negative impact on the health of the infected person and increase the risk of transmitting the virus to others.
The START International Study demonstrated the benefit of early initiation of ART, but a long-term follow-up of 4,446 participants was performed to determine whether the health benefits of ART compared to late ART increased, remained constant or decreased after participants in the ART arm. Late retrograde. They were instructed to start ART. The study’s primary endpoints included the number of participants who contracted AIDS. Those who have developed serious health problems unrelated to AIDS, such as major cardiovascular disease, kidney failure, liver disease, and cancer; and those who died.
For participants who started ART before the end of 2015, the mean CD4+ cell count at the time of ART initiation was 648 cells/mm for the immediate arm and 460 cells/mm for the late arm. The analysis presented today compared the study’s initial endpoints before the end of 2015, with those for the extended follow-up period, from January 1, 2016 to December 31, 2021. During this last period, most participants in the deferred arm were taking ART. During the second period, subjects initiating antiretroviral therapy in the delayed group experienced a rapid and sustained reduction in viral load of HIV (< or equal to 200 copies/ml); However, the CD4+ cell count remained, on average, 155 cells lower than that of individuals in the direct ART group. Although the risk of serious health effects was significantly reduced soon after initiation of ART in the delayed-treatment group, some increased risks remained compared to the immediate-treatment group. The delayed ART group continued to have a slightly higher (21%) risk of serious health consequences or death than the immediate treatment group. And 27 cases of AIDS occurred during the five-year follow-up period in the late-treatment group, compared to 15 in the early-treatment group. Similarly, 88 cases of serious health problems not related to AIDS occurred in the delayed treatment group compared to 76 cases in the immediate treatment group. Finally, there were 57 deaths in the delayed treatment group versus 47 in the immediate treatment group.
These findings confirm that ART significantly improves the health of a person living with HIV and reduces the risk of AIDS and serious health problems, and that early diagnosis and treatment are essential to maximizing these benefits and minimizing risks, according to the presenters.
The START study and its extended follow-up were conducted by the International Network for Strategic Initiatives in Global Trials on HIV (INSIGHT), funded in part by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. It was led by principal investigator James D. Neaton, PhD, of the University of Minnesota, Minneapolis, and START study co-chairs Abdel-Babaker, PhD, of University College London, and Jens Lundgren, MD, of the University of Copenhagen.
