TREATMENT GUIDELINES: START considers early treatment improves outcomes for people living with HIV

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CD4 - The Key Point in People's Health with HIV
And behold the sun of a new day comes to shine
And behold the sun of a new day comes to shine

Starting with a CD4 cell count greater than 500 / mm3 is safer than waiting until 350 cells / mm3

A large international randomized clinical trial has shown that HIV-infected persons have a significantly lower risk of developing AIDS or other serious diseases if they start antiretroviral therapy (ART) earlier when their CD4 cell count is higher, rather than wait until the CD4 cell count drops to lower levels.

The study unequivocally demonstrates that the onset of ART before a person's CD4 count falls below 500 cells / mm3 leads to fewer illnesses and fewer adverse events, both AIDS-defining and non-AIDS defining AIDS, compared to waiting until your CD4 count drops below 350 cells / mm3.

These results are likely to have a major impact on international treatment guidelines. The US National Institutes of Health commented in its press release that "Together with data from previous studies it has been demonstrated that early antiretroviral treatment reduced the risk of HIV transmission to uninfected sexual partners, these findings indicate that treatment should be offered for all people with HIV. "

The Strategic Timing of Antiretroviral Treatment (START) study, was a large randomized clinical trial that tested whether ART benefited all people living with HIV. Its predecessor, the SMART study had a huge impact when he showed on 2006 that getting on ART was better than interrupting it. As in the previous study, START was discontinued early. Although expected to be completed by December of 2016, a mid-term review of the study data by the independent study by the Data and Safety Monitoring Committee (DSMB) recommends that results be released earlier.

START, which began in March of 2011, was carried out by the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) in 215 locations in 35 countries. In the study were enrolled 4.685 men and women with HIV who had never taken ART. There were people with 18 years and older, with a median age of 36 years, and the initial CD4 count of all study subjects were above 500 cells / mm3.

Half of the study participants were randomized to start ART immediately and the other half postponed treatment until the CD4 + T cell count fell to 350 cells / mm3. On average, participants in the study were followed for a period of three years.

The study measured the combination of outcomes that included severe AIDS events (such as AIDS-related cancer), "severe-defining AIDS (cardiovascular, kidney and liver disease and cancer), and death.

Based on March data from 2015, the DSMB found 41 cases of AIDS, severe-AIDS or death among those enrolling in the ART early-onset group compared to 86 events in which delayed treatment was delayed. The people who will henceforth initiate, if there is the political will and the "economic will" to do so, I feel "kind" when a study goes so far as to get serious results and even I know of informed consent and I also know of very close people within the community that I Facebook who, desperate for a cure, enrolled in any study that gave them "a thread of hope"

This equates to a reduction of 53% in the risk of developing severe illness or death. The reduction of risk was even more pronounced for the "development of AIDS".

Findings were consistent across sites and the benefits of ART were similar for low, middle, and high income people.

"Now we have clear evidence that it is of far greater benefit to the health of a person infected by HIV VIRUS for

Digital illustration of virus
Digital illustration of HIV

start antiretroviral therapy sooner than later, "said NIAID director Anthony SS Fauci.

He added: "In addition, early therapy conveys a double benefit, not only improving people's health, but simultaneously, decreasing their viral loads, minimizing the risk of HIV transmission. These findings have global implications for HIV treatment. "

"This is an important milestone in HIV research," said Jens Lundgren, MD, of the University of Copenhagen and one of the co-chairs of the early study. "We now have strong evidence that early treatment is beneficial for seropositive patients. These results support the initiation of treatment independently of the CD4 count.

Current HIV treatment guidelines from the World Health Organization recommend that HIV-infected persons start ART when their CD4 count falls to 500 cells / mm3, but some guidelines, including the British HIV Association (BHIVA) guidelines, we recommend waiting for counts of CD4 to fall below 350 cells / mm3.

In light of the DSMB findings, study researchers are informing all participants of the interim results. Participants will be offered treatment if they are no longer on antiretroviral treatment, and they will continue to be followed until the end of 2016.

For more information, see the The NIH Press Release

Claudio-panamaTranslated from the original into English in START trial finds that early treatment improves outcomes for people with HIV by Claudio Santos de Souza on 28 May 2015. Original Gus Cairns publication in 27 May 2015

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