ART sooner rather than later for adults with HIVBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f377 (Published 23 January 2013) Cite this as: BMJ 2013;346:f377
Earlier treatment with antiretroviral drugs (ART) delayed progression of HIV in two recent studies, and a linked editorial says there is now compelling evidence that HIV should be treated sooner rather than later (p 279). Guidelines from well resourced countries already recommend treating everyone with HIV regardless of their immune status. These studies add much needed hard evidence to support the consensus, writes the author.
The strongest evidence emerged from a randomised trial of 48 weeks of ART, started within six months of seroconversion. This strategy delayed progression by 65 weeks compared with standard care (95% CI 17 to 114). During four years of follow-up, men and women treated early and for 48 weeks were significantly less likely to reach an immunological threshold that would normally trigger treatment (50% (61/123) v 61% (75/123); hazard ratio 0.63, 0.45 to 0.90). A third group of adults who were treated early for just 12 weeks did no better than controls.
The second study reported observational analyses in a cohort of mostly men from the US. Researchers identified a window of opportunity for treatment, lasting four months after initial HIV infection and coinciding with an early transient recovery of CD4+ cell counts. Men who began ART during this window had more favourable immune trajectories than others—their CD4+ cell counts recovered faster and were more likely to reach at least 900×106/L (64% v 34%; P<0.001) within four years.
Neither study was able to show that earlier treatment prevented AIDS or deaths, however.
Cite this as: BMJ 2013;346:f377