A major international randomised clinical trial has found that people living with HIV should start taking medication sooner rather than waiting.
The The Strategic Timing of AntiRetroviral Treatment (START), found that people living with HIV were less likely to have health problems later on, if they began taking antiretroviral treatment (ART) when their CD4 cell count was higher, compared to waiting until it dropped to lower levels.
Clear results showed that those starting ART before their CD4 count dropped below 500 cells/mm3 led to less illnesses and fewer adverse events, compared to those who waited until their CD4 count dropped to below 350 cells/mm3.
The US National Institutes of Health comment in their press release: “Together with data from previous studies showing that antiretroviral treatment reduced the risk of HIV transmission to uninfected sexual partners, these findings support offering treatment to everyone with HIV.”
The START study was a large-scale randomised clinical trial, opened in 2011 and was conducted by the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) at 215 sites in 35 countries.
The trial enrolled 4685 men and women with HIV who had never taken ART. They were aged 18 and older, with a median age of 36, and their CD4 counts were all over 500 cells/mm3.
Half of participants started ART immediately, and the other half waited until their CD4 count dropped.
“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,” said Anthony S. Fauci, Director of the US National Insititute of Allergy and Infectious Disease (NIAID).
He added: “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.”
Dr Rosemary Gillespie, Chief Executive at Terrence Higgins Trust, said: “This ground-breaking research adds to the growing body of evidence that shows there should be no delay in starting HIV treatment. Early diagnosis and treatment mean that people living with HIV can expect to live long and healthy lives, and can also reduce the chances of HIV being passed on unwittingly. They are key tools in our efforts to stop the spread of HIV in the UK
“World Health Organisation guidelines already recommend that people diagnosed with HIV start antiretroviral treatment (ART) when their CD4 counts fall to 500 cells/mm3, but some guidelines, including those of the British HIV Association (BHIVA), still recommend waiting until CD4 counts fall below 350 cells/mm3.
“As a matter of urgency we hope BHIVA and NHS England will take account of this latest research in the current BHIVA review of guidelines to recommend that people diagnosed with HIV begin treatment at the earliest possible opportunity.”
“At the moment, certain groups such as at-risk gay men can ask their doctors to start ART earlier but we want to see this treatment available to all newly diagnosed people. The benefits to them and their partners outweigh the costs.”