TUESDAY, Oct. 25, 2022 (HealthDay News) — Initiating antiretroviral treatment (ART) early in the course of HIV infection results in better outcomes compared with deferred initiation, although the difference in ongoing excess risk is reduced with long-term follow-up, according to a study presented at the annual meeting of the Infectious Diseases Society of America (IDWeek), held from Oct. 19 to 23 in Washington, D.C.

James D. Neaton, Ph.D., of the University of Minnesota in Minneapolis, and colleagues randomly assigned 4,684 ART-naive HIV-positive adults with CD4 >500 cells/µL to start ART immediately (IMM; 2,325 participants) or defer ART until CD4 <350 cells/µL or development of AIDS (DEF; 2,359 participants). In 2015, a 57 percent reduction in the risk for the primary end point of AIDS, serious non-AIDS (SNA) condition, or death was seen for IMM ART. Participants assigned to DEF were recommended to initiate ART, with follow-up to Dec. 31, 2021.

The researchers found that ART initiation led to a rapid decline in HIV RNA to ≤200 copies/mL during both time periods. The benefit of IMM versus DEF was reduced in post-2016 versus pre-2016 for the primary end point (hazard ratios [95 percent confidence intervals], 0.47 [0.34 to 0.64] and 0.75 [0.56 to 1.01] for pre-2016 and post-2016, respectively) and its components. The hazard ratio for the primary end point was 0.61 (95 percent confidence interval, 0.49 to 0.76) from randomization to 2021.

“Among people with CD4 >500, the excess risk of AIDS and SNA conditions associated with delaying ART initiation is substantially diminished soon after ART is initiated, but persistent excess risk remains,” the authors write.

One author disclosed financial ties to the pharmaceutical industry.

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