{"id":1531,"date":"2011-04-18T21:37:11","date_gmt":"2011-04-19T01:37:11","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=1531"},"modified":"2015-06-04T15:23:45","modified_gmt":"2015-06-04T19:23:45","slug":"when-to-start-antiretroviral-therapy-take-3","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/when-to-start-antiretroviral-therapy-take-3\/2011\/04\/18\/","title":{"rendered":"When to Start Antiretroviral Therapy, Take 3"},"content":{"rendered":"

\"\"<\/a>A third observational study on “When to Start ART” has just appeared <\/a>in the Annals of Internal Medicine<\/em>,\u00a0 “The HIV-CAUSAL Collaboration.”<\/p>\n

As with ART-CC<\/a> and NA-ACCORD<\/a>, it’s a large study, starting with over 20,000 people with HIV with baseline CD4s >500 receiving care in Europe and the United States.\u00a0 Out of this group, 8392 experienced CD4 declines into the 200-500 range and are included in this analysis.\u00a0 Outcomes of interest are mortality and new AIDS-related events, depending on when combination ART (“cART”<\/a>) was started.<\/p>\n

The results?<\/p>\n

Initiation of cART at a threshold CD4 count of 500 increases\u00a0AIDS-free survival. However, mortality did not vary substantially with the use of CD4 thresholds between 300 and 500.<\/p><\/blockquote>\n

The authors also cite a “number needed to treat” of 48 for starting at 500 rather than 350 for prevention of AIDS or death, a fairly low number when compared to some interventions widely adopted in cardiovascular disease.<\/a><\/p>\n

While not the blockbuster results of the NA-ACCORD study — whose nearly two-fold reduction in mortality for starting at >500 remains both unreproduced and, let’s face it, unexplained — these results still point to a substantial clinical benefit of starting ART before CD4s fall too low.<\/p>\n

In addition, none of these large observational studies even hints at a negative effect of starting early on clinical outcomes, and other potential benefits of treating HIV (reduced risk of HIV transmission, reduced long-term incidence of non-AIDS events) can’t be included.<\/p>\n

As nicely summarized in the accompanying editorial<\/a>,\u00a0the quantitative benefits of early ART can’t come close to the benefits of late<\/em> ART, which are nothing short of miraculous.<\/p>\n

It’s up to us — patients, providers, society — to determine whether early ART is worth it.<\/p>\n","protected":false},"excerpt":{"rendered":"

A third observational study on “When to Start ART” has just appeared in the Annals of Internal Medicine,\u00a0 “The HIV-CAUSAL Collaboration.” As with ART-CC and NA-ACCORD, it’s a large study, starting with over 20,000 people with HIV with baseline CD4s >500 receiving care in Europe and the United States.\u00a0 Out of this group, 8392 experienced […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,5,8,10],"tags":[62,83,148,423,992],"class_list":["post-1531","post","type-post","status-publish","format-standard","hentry","category-hiv","category-infectious-diseases","category-patient-care","category-research","tag-annals-of-internal-medicine","tag-art","tag-cart","tag-hiv","tag-when-to-start"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/1531","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=1531"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/1531\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=1531"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=1531"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=1531"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}