Starting antiretroviral (ARV) treatment for HIV before CD4 cells drop too low reduces the risk of AIDS and HIV-related illnesses, according to the same large study that proved early ARV treatment reduces the risk of HIV transmission by 96 percent, aidsmap reports. Called HPTN 052, the study was a large multi-site trial conducted in 13 sites in nine countries. Results were published in Lancet Infectious Diseases.
The trial randomized 1,762 HIV-positive participants who had CD4s between 350 and 550 to either begin ARVs immediately or to wait until their CD4 levels had either dropped to 250 or until they developed a symptomatic disease related to HIV. The median CD4 count at the study’s outset was 436. The participants were followed for a median of 2.1 years.
A total of 57 participants (6 percent) who started treatment early and 77 (9 percent) who delayed treatment experienced one or more of the following (considered a “primary outcome”): death, an AIDS diagnosis, tuberculosis (TB), a severe bacterial infection, cardiovascular disease, serious liver or kidney disease, non-AIDS cancers or diabetes. The cumulative two-year probability of such an outcome was 4.8 percent for the early treatment group, compared with 7.9 percent for the delayed treatment cohort. Although there was a 27 percent reduced risk of a primary outcome among those who started early, this difference was not statistically significant, meaning it could have occurred by chance.
Five percent of those in the early treatment group were diagnosed with an AIDS-defining event, compared with 7 percent among those who delayed treatment. The cumulative two-year probability of an AIDS diagnosis was 3.3 percent in the group that started ARVs early and 6 percent in those who delayed. Starting treatment early lowered the risk of an AIDS-defining illness by 36 percent, a difference that was statistically significant.