- Immediate antiretroviral therapy (ART) reduces risk for a broad spectrum of severe bacterial infections in HIV-infected patients, and appears to be mediated partly by increases in CD4 cell count, but not neutrophils.
Why this matters
- Effect of early ART on bacterial infections is important because these events are common in HIV-infected patients.
- After median follow-up of 2.8 y, 120 of 4685 HIV-positive patients had severe bacterial infections (immediate-initiation group n=34, deferred-initiation group n=86).
- Immediate vs deferred ART was associated with reduced risk for severe bacterial infection (HR, 0.39; P<.0001).
- Average neutrophil and CD4 cell counts were 321.4 cells per μL and 194.2 cells per μL higher, respectively, in immediate- vs deferred-initiation groups (P<.0001).
- On univariable analysis, higher time-updated CD4 cell count, but not neutrophil count was associated with reduced risk for severe bacterial infection.
- After adjustment for time-updated CD4 cell count in multivariable models, HR for immediate-initiation group moved toward 1 (HR, 0.84; P=.52).
- Preplanned secondary analysis of START to determine effects of immediate ART on all severe bacterial infections.
- Funding: Various international government sources, including National Institutes of Health.
- Bacterial pneumonia and tuberculosis reported as main endpoints; few events limits study power.