- Deferred/intermittent antiretroviral therapy (ART) increases AIDS, serious non-AIDS (SNA), cardiovascular (CVD) events, cancer incidence among people living with HIV (PLWH).
Why this matters
- Reinforce/communicate benefits of early, continuous ART among PLWH (e.g., protecting health of partner/offspring, decreasing hospitalization and noncommunicable disease risk).
- 10,156 participants (5472 SMART [Strategies for Management of Antiretroviral Therapy], 4684 START [Strategic Timing of AntiRetroviral Treatment]).
- Compared with deferred/intermittent ART, immediate/continuous ART participants had HIV RNA level 400 copies/mL during 84.2% (vs 33.3%) of follow-up time.
- Pooled HRs of deferred/intermittent vs immediate/continuous were 3.63 (95% CI, 2.37-5.56) for AIDS, 2.06 (95% CI, 1.65-2.56) for SNA, 2.06 (95% CI, 1.65-2.56) for AIDS, SNA, or death composite.
- In both SMART and START, pooled HRs were 1.59 (95% CI, 1.07-2.37) for CVD, 19.3 (95% CI, 1.32-2.83) for cancer.
- Deferred/intermittent ART was consistently associated with increased composite outcome of AIDS, SNA, or death events across subgoups (interaction P>.25).
- See related editorial.
- Comparative analysis of pooled data from SMART, START trials quantifying relative difference between deferred/intermittent and intermediate/continuous ART on risk of AIDS, non-AIDS-defining events.
- Funding: NIH.
- Heterogeneous risk profiles.
- Underpowered to evaluate some risk outcomes.
- Some undiagnosed outcomes.