Antiretroviral treatment at diagnosis

08 June 2015

People infected with HIV benefit significantly from starting HIV drugs as soon as possible, according to a major international randomised clinical trial. An interim analysis of the Strategic Timing of AntiRetroviral Treatment (START) trial, involving 4,685 HIV-infected men and women who had never previously been treated with antiretroviral medication, revealed that the risk of  developing serious illness (AIDS-related events or serious non-AIDS events) was reduced by 53% in those individuals who had received treatment immediately upon diagnosis. Participants in the study funded largely by the US National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health who had a CD4 T-cell count > 500 cells/mm3 were randomised to either immediate treatment or when the CD4 count had dropped to 350 cells/mm3.  The NIAID director, Anthony Fauci, said “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.”  Based on these interim findings, all patients participating in the trial are now being given antiretroviral treatment. “ These findings have global implications for the treatment of HIV,” said Fauci. Professor Peter Reiss, director of Stichting HIV Monitoring, supported this view, saying “We have long suspected that immediate treatment would be beneficial, but lacked the clinical trial evidence to back it up. The START trial has provided this evidence and supports the idea that treatment should be recommended to everyone infected with HIV, regardless of someone’s CD4 count.”