HIV: early, continuous ART tied to lower risk for AIDS, complications

  • Borges ÁH & al.
  • J Infect Dis
  • 7 Jan 2019

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • 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).

Key results

  • 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.

Study design

  • 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.

 Limitations

  • Heterogeneous risk profiles.
  • Underpowered to evaluate some risk outcomes.
  • Some undiagnosed outcomes.