A trial funded by the National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID) has found that HIV-infected individuals have a lower risk of developing AIDS or other serious illnesses if they start taking antiretroviral drugs soon after they are first diagnosed.
The trial’s findings could have significant implications for worldwide treatment guidelines for people infected with HIV. In the United States, people diagnosed with HIV are encouraged to seek treatment as soon as possible, even if they are asymptomatic. The current guidelines for the World Health Organization recommend that HIV-positive people begin antiretroviral treatment only when their CD4+ cell count — meaning the amount of T-helper cells, or white blood cells that help to fight off infections — falls to 500 cells per cubic millileter or less.
The Strategic Timing of AntiRetroviral Treatment (START) study began in March 2011, looking at 4,685 HIV-infected individuals over the age of 18 from 215 sites in 35 different countries. Participants had CD4+ cell counts in the normal range (above 500) with half being prescribed antiretrovirals immediately, and the other half asked to defer treatment until their CD4+ cell count declined to 350 cells/mm3. The START study looked at various health outcomes for both groups, including the incidence of AIDS-related cancer, cardiovascular, renal or liver disease, and death.
The study found 41 instances of AIDS, serious non-AIDS events, or death among those in the “early treatment” group compared to 86 events in the deferred treatment group. Subsequent analysis by an independent data and safety monitoring board found risk of developing serious illness or death was reduced by 53 percent among those in the early treatment group. The study also found that serious AIDS-related events and serious non-AIDS-related events were both lower in the early treatment group than the deferred treatment group, with findings consistent across geographic regions, with benefits of early treatment similar for participants from low- and middle-income countries and those from high-income countries.
As a result of the study’s findings, investigators are informing all participants of the interim results, and will offer treatment to those not currently on antiretroviral therapy.
“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,” Dr. Anthony S. Fauci, the director of NIAID, 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.”
Dr. Raymond Martins, the chief medical officer for local community health center Whitman-Walker Health, which specializes in HIV treatment, said the takeaway from the START study findings is that people diagnosed with HIV need to seek out support that will allow them to accept their diagnosis and seek treatment as soon as possible, rather than delaying until they become very sick.
“What people overall and in D.C. can take from this is, ‘If you are diagnosed with HIV, get into treatment as soon as possible,'” Martins said. “People who enter care earlier have better health outcomes, not only in terms of their immune system, but the rest of their health systems, because they’re engaged in care with a regular medical provider.”
On a more global scale, Martins notes that the U.S. guidelines with respect to starting antiretroviral treatment have been more progressive than those put forth by the World Health Organization (WHO), but also notes that the WHO may have been taking into account the ability of people to pay and the type of drugs that can be accessed in other countries when making its recommendations.
Martins added that, in the District, there can be a misperception about the costs associated with seeking treatment.
“D.C. is much more similar to Massachusetts than other states in terms of health care,” Martins said, noting that, for example, 96 percent of people going to Whitman-Walker for treatment have some form of health insurance, and some low-income D.C. residents qualify for special programs or public benefits that will help cover their treatments. “Insurance should never be a barrier to seeking care.”
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