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The following is a summary of “Risk of severe bacterial infections including TB before and after immediate or deferred antiretroviral therapy: a multicenter, prospective, cohort study,” published in the April 2025 issue of International Journal of Infectious Diseases by Jensen et al. 

Researchers conducted a retrospective study to specify whether the increased risk of severe bacterial infections and tuberculosis (TB) in people with HIV (PWH) due to deferring antiretroviral therapy (ART) until a CD4 count below a certain threshold was reversed after ART initiation.  

They analyzed data from 4,684 adult PWH with CD4 counts above 500 cells/mm³, randomized to immediate or deferred ART in the Strategic Timing of Anti-Retroviral Treatment (START) trial. In May 2015, the deferred group was offered ART, with follow-up continuing until December 2021. Cox proportional hazards models were employed to compare the risk of severe bacterial infections, including TB, in both groups before and after ART initiation in the deferred group.  

The results showed that 217 participants (4.6%) experienced a severe bacterial infection during the follow-up period. Prior to 2016, the immediate ART group had a lower rate of severe bacterial infections compared to the deferred ART group (hazard ratio [HR] 0.38; 95% confidence interval [CI] 0.26, 0.55). From 2016 to 2021, no significant difference was observed between the groups (HR 0.75; 95% CI 0.49, 1.16) and no differences were found across clinical or demographic subgroups.  

Investigators concluded that the elevated risk of serious bacterial infections observed after delaying ART was mitigated upon the commencement of ART. 

Source: ijidonline.com/article/S1201-9712(25)00134-1/fulltext