Are you infected with HIV? If this is the case, HIV treatment can improve your quality of life and help you live a healthier life for longer. However, starting treatment is a big step. To get the most out of HIV medications, they must be taken exactly as prescribed. The way you take your medication is just as important as the drugs you and your doctor choose. So, before you begin, it is critical to be prepared and committed to taking your HIV medications correctly and consistently for your own health. This requires a combination of the right health care provider, adequate HIV knowledge, and a positive attitude.
According to findings presented today at the IDWeek Conference in Washington, D.C., starting antiretroviral treatment (ART) early in the course of HIV infection when the immune system is stronger results in better long-term health outcomes than delaying ART.
The results are based on a long-term follow-up of participants in the National Institutes of Health-funded Strategic Timing of Antiretroviral Treatment (START) study. START demonstrated a 57% reduction in the risk of AIDS and serious non-AIDS health outcomes in 2015 among participants who started ART when their CD4+ T-cell counts – a key indicator of immune system health – were greater than 500 cells per cubic millimeter (mm3), compared to those who did not start ART until their CD4+ counts fell below 350 cells/mm3 or they developed AIDS. Following the publication of these findings in 2015, those in the deferred treatment arm were advised to begin ART.
Findings confirm that ART significantly improves an individual’s health and reduces the person’s risk of developing AIDS and serious health issues, and that early diagnosis and treatment are critical to maximizing these benefits and reducing risk.
According to the Centers for Disease Control and Prevention, approximately 1.2 million people in the United States have HIV, and approximately 13% are unaware that they are infected. HIV continues to replicate when HIV diagnosis and treatment are delayed. This can have a negative impact on the infected person’s health and increase the risk of the virus spreading to others.
The international START study demonstrated the benefit of early ART initiation, but a longer-term follow-up of 4,446 participants was conducted to determine whether the health benefits of early ART versus deferred ART increased, remained constant, or declined after the deferred arm participants were advised to begin ART.
The primary study endpoints included the number of participants who developed AIDS; those who developed serious non-AIDS health conditions, such as major cardiovascular disease, kidney failure, liver disease, and cancer; and those who died.
The median CD4+ cell count at the time of ART initiation for participants who began ART before the end of 2015 was 648 cells/mm3 for the immediate arm and 460 cells/mm3 for the deferred arm. The analysis presented today compared the primary study endpoints before the end of 2015 with those in the extended follow-up period, which ran from January 1, 2016, to December 31, 2021. ART was used by the majority of deferred-arm participants in the latter period. During the second period, people starting ART in the deferred group had rapid and sustained declines in HIV viral load (less than or equal to 200 copies/mL); however, CD4+ cell counts remained 155 cells lower on average than those in the immediate ART group.
While the risk of serious health outcomes was significantly reduced in the deferred treatment group soon after ART was initiated, some excess risk remained when compared to the immediate treatment group. In comparison to the immediate treatment group, the deferred ART group continued to have a slightly higher risk (21%) of serious health consequences or death.
During the five-year follow-up period, 27 cases of AIDS occurred in the deferred treatment group, compared to 15 cases in the early treatment group. Similarly, in the deferred treatment arm, 88 cases of serious non-AIDS health issues occurred, compared to 76 cases in the immediate treatment arm. Finally, 57 people died in the deferred treatment group versus 47 in the immediate treatment arm.
According to the presenters, these findings confirm that ART significantly improves an individual’s health and reduces the person’s risk of developing AIDS and serious health issues, and that early diagnosis and treatment are critical to maximizing these benefits and reducing risk.