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Greater Benefit for Early Antiretroviral Tx Initiation in HIV

NIH-funded trial results appear likely to impact global treatment guidelines

FRIDAY, May 29, 2015 (HealthDay News) -- Patients with HIV should start antiretroviral therapy as soon as they're diagnosed, according to research findings from the Strategic Timing of AntiRetroviral Treatment (START) study, the first large-scale randomized clinical trial to establish that earlier antiretroviral treatment benefits all HIV-infected individuals.

The study started in 2011; 4,685 HIV-infected men and women took part at 215 sites in 35 countries. About half were randomly assigned to begin antiretroviral therapy immediately, while the other half didn't start the treatment until their CD4+ cell count declined to 350 cells/mm³.

As of March, researchers found 41 cases of serious events -- such as progression to AIDS; AIDS-related cancer; and major cardiovascular, renal and liver disease -- or death in those who started the treatment early, compared to 86 in those who started the treatment later. Patients who took the drugs earlier also fared better no matter where they lived and regardless of the wealth of their respective countries. The scientists involved in the trial were so impressed by the health benefits of early use of HIV drugs that they halted the study early so they could offer the medications to all participants.

"We now have clear-cut proof that it is of significantly greater health benefit to an HIV-infected person to start antiretroviral therapy sooner rather than later," Anthony Fauci, M.D., director of the U.S. National Institute of Allergy and Infectious Diseases, said in a statement. "Moreover, early therapy conveys a double benefit, not only improving the health of individuals but at the same time, by lowering their viral load, reducing the risk they will transmit HIV to others. These findings have global implications for the treatment of HIV."

The HIV medications used in the trial were donated by AbbVie, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline/ViiV Healthcare, Janssen, and Merck Sharp & Dohme.

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