Early HIV Diagnosis and Treatment Key to Better Long-Term Outcomes

WASHINGTON — Starting antiretroviral treatment early in the course of HIV infection, when the immune system is stronger, results in better long-term health outcomes compared with delaying antiretroviral treatment, according to a study presented at the IDWeek Conference in Washington last week.

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The START study and its extended follow up was conducted by the International Network for Strategic Initiatives in Global HIV Trials, with its efforts being funded in part by the National Institute of Allergy and Infectious Diseases.

Approximately 1.2 million people in the United States are living with HIV, and roughly 13% do not know they are infected, according to the Centers for Disease Control and Prevention. 

When HIV diagnosis and treatment are delayed, HIV continues to replicate. This can negatively impact the infected individual’s health and increase the risk of transmitting the virus to others.

The international START study was begun in 2015 and proved the benefit of early antiretroviral treatment initiation.

A longer-term follow-up of 4,446 participants was undertaken to determine whether the health benefits of early antiretroviral treatment compared with deferred treatment increased, remained constant or declined after the participants in the deferred arm were advised to begin antiretroviral treatment. 

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 analysis, presented on Friday, Oct. 21, compared the primary study endpoints before the end of 2015 with those in the extended follow-up period, from Jan. 1, 2016, to Dec. 31, 2021. 

In the latter period, most deferred-arm participants were taking antiretroviral treatment. During the second period, people initiating 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, on average, 155 cells lower compared with that of individuals in the immediate ART group. 

While the risk of serious health outcomes was substantially diminished soon after antiretroviral treatment was initiated in the deferred treatment group, some excess risk remained compared with the immediate treatment group. 

Twenty-seven cases of AIDS occurred in the five-year follow-up period in the deferred treatment group compared with 15 cases in the early treatment group. 

Similarly, 88 cases of serious non-AIDS health issues occurred in the deferred treatment arm compared with 76 cases in the immediate treatment arm. 

Lastly, there were 57 deaths in the deferred treatment group compared to 47 in the immediate treatment arm.   

These findings confirm that ART significantly improves the health of an individual with HIV and reduces the person’s risk of developing AIDS and serious health issues, and that early diagnosis and treatment are key to maximizing these benefits and reducing risk, according to the presenters. 

The study was led by principal investigator James Neaton, Ph.D., of the University of Minnesota, Minneapolis, and START study co-chairs Abdel Babiker, Ph.D., of the University College London, and Jens Lundgren, M.D., of the University of Copenhagen.