MONTREAL — Mounting evidence suggests a substantial survival benefit associated with immediate initiation of antiretroviral therapy in adults with HIV, compared with deferred treatment, investigators reported at the Conference on Retroviruses and Opportunistic Infections.
Although treatment guidelines recommend starting antiretroviral therapy when CD4 T cells fall below 350 cells/mm
In one of the two studies, the increased risk of death associated with treatment deferral was about 40%, according to lead investigator Dr. Mari Kitahata of the University of Washington, Seattle.
As part of the North American AIDS Cohort Collaboration on Research and Design observational study, Dr. Kitahata and colleagues compared the outcomes of 2,620 HIV-positive adults who began highly active antiretroviral therapy (HAART) when their CD4 cell counts were higher than 500 cells/mm
The relative risk of death among patients in the deferral group was 1.4, compared with the early initiators, Dr. Kitahata said.
Data from the North American and European When to Start Consortium also showed a survival advantage for earlier treatment. The findings of the retrospective examination of 15 cohort studies indicated that HIV-positive adults whose CD4 cell count was between 251 and 350 cells/mm
All of the 21,247 patients included in the analysis began treatment for the first time when their CD4 cell count fell below 550 cells/mm
Although starting therapy with a CD4 cell count above 350 cells/mm
Although the findings of both studies suggest that the current treatment guidelines might be too conservative, neither study can offer a definitive answer, Dr. Sterne said at a press briefing.
Dr. Kitahata and Dr. Sterne had no financial disclosures to report.