⁃ We now know many more people should be offered ARVs than previously thought
The results of a critical study determining when HIV-positive people should start taking antiretroviral therapy were announced last week – more than a year early. The START (Strategic Timing of Antiretroviral Treatment) trial found that it is better for people living with HIV to start treatment at CD4 counts above 500 cells/mm3 and not to wait for CD4 counts to drop to 350 or below. Prior to the START results it was unclear whether or not HIV-positive people benefited from treatment above CD4 counts of 350.
In the trial 4,685 HIV-positive people were randomized to either initiate antiretroviral therapy immediately (at CD4 counts above 500) or to delay treatment until CD4 counts drop to 350 or below. At a recent review of the trial’s data safety monitoring board it was discovered that there was a statistically significant difference between the two groups. Therefore the participants on the delayed treatment arm (CD4 count 350 or below) are now all being offered treatment.
In the delayed treatment arm there were 86 cases of AIDS, serious non-AIDS events or death compared to 41 in the early treatment arm. More specifically, in the delayed treatment arm there were 46 cases of AIDS or death compared to 14 in the early treatment arm.
More detailed findings than what is available now will be released at the 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver in July. The additional data will help us form a more complete picture about the impact of earlier treatment. The START trial is continuing along with a number of important sub-studies.
The START findings show that earlier treatment is better. As a result, we now know that many more people should be offered treatment than what we thought previously.
TAC acknowledges the important contribution of all the healthcare workers and people living with HIV who made the START trial possible.
⁃ TAC will in the coming months be publishing an updated and more detailed policy position on HIV treatment in South Africa.
For more information contact Marcus Low on 082 962 8309