Antiretroviral treatment (ART) that is initiated early in the course of HIV infection when the immune system is stronger has better long-term health outcomes than ART that is initiated later, according to research findings presented at the IDWeek Conference in Washington.
The findings are based on a thorough follow-up of participants in the National Institutes of Health-funded Strategic Timing of Antiretroviral Treatment (START) trial.
START discovered in 2015 that individuals who began antiretroviral therapy (ART) when their CD4+ T-cell counts—a crucial indicator of immune system health—were higher than 500 cells per cubic millimetre (mm3) had a 57% lower risk of developing AIDS and serious non-AIDS health outcomes than those who waited until either their CD4+ counts fell below 350 cells/mm3 or they contracted AIDS. After these results were published in 2015, the patients in the postponed treatment arm were advised to begin ART.
The Centers for Disease Control and Prevention estimate that 1.2 million Americans are HIV +, with 13% of them being uninformed of their status. If treatment and diagnosis are postponed, HIV continues to reproduce.
As a result, there may be negative effects on the infected person’s health as well as an increased likelihood of the virus spreading to other people.
A longer-term follow-up of 4,446 participants was conducted to determine whether the health benefits of early ART compared to deferred ART increased, remained the same, or decreased after the participants in the deferred arm were advised to start ART. The international START study had already established the value of early ART initiation.
The primary objectives of the trial were the number of people who developed AIDS, those who developed severe non-AIDS illnesses like significant cardiovascular disease, kidney failure, liver disease, and cancer, as well as those who died.
Participants who began ART before the end of 2015 had median CD4+ cell counts of 648 cells/mm3 for the immediate arm and 460 cells/mm3 for the postponed arm. The key research endpoints that occurred before the end of 2015 were compared to those that occurred during the extended follow-up period, which lasted from January 1, 2016, to December 31, 2021, in the analysis that was presented today. The majority of individuals in the deferred-arm group were taking ART at this point.
During the second phase, those beginning ART in the postponed group saw rapid and sustained decreases in HIV viral load (less than or equal to 200 copies/mL), but their CD4+ cell counts stayed, on average, 155 cells lower than those of those beginning ART immediately.
Although the risk of adverse health consequences was much lower in the deferred treatment group than it was in the immediate treatment group shortly after ART was initiated, some excess risk persisted.
In comparison to the group receiving urgent treatment, the deferred ART group continued to have a slightly higher chance (21%) of experiencing major health issues or passing away. In the deferred treatment group, there were 27 instances of AIDS throughout the five-year follow-up period, compared to 15 cases in the early treatment group.
The deferred treatment arm saw 88 significant non-AIDS health concerns, compared to 76 in the urgent treatment arm. The deferred treatment group saw 57 deaths, compared to 47 in the immediate treatment group.
These findings support the notion that ART dramatically enhances the health of HIV-positive people and reduces their risk of developing AIDS and other life-threatening diseases. To maximise these benefits and reduce risk, the presenters contend that early identification and treatment are crucial.