When to start HIV Therapy

[Jim Allen]

There is clear-cut proof of the significantly greater health benefit to a person living with HIV starting antiretroviral therapy sooner rather than later; treatment should start regardless of viral load or CD4 counts.

Hence, it's now recommended not to wait anymore and that anyone living with HIV, including Elite Controllers, should begin antiretroviral treatment as soon after diagnosis as possible.

Anyone looking for information on starting treatment can begin by reading this brief and useful lesson: Starting treatment https://www.poz.com/basics/hiv-basics/starting-hiv-treatment

If you are newly diagnosed and reading this, please note that with HIV treatment (ART), Life expectancy for young people living with HIV has reached near normal.

Jim


References:
 
Long-Term Study Results Confirm Benefits of Early HIV Treatment
https://www.poz.com/article/longterm-results-confirm-benefits-early-hiv-treatment

http://www.who.int/mediacentre/news/releases/2015/hiv-treat-all-recommendation/en/
Anyone infected with HIV should begin antiretroviral treatment as soon after diagnosis as possible, WHO announced with its "treat-all" recommendation, WHO removes all limitations on eligibility for antiretroviral therapy (ART) among people living with HIV; all populations and age groups are now eligible for treatment.

The expanded use of antiretroviral treatment is supported by recent findings from clinical trials confirming that early use of ART keeps people living with HIV alive, healthier and reduces the risk of transmitting the virus to partners.[/b]

http://betablog.org/start-trial-shows-benefits-of-early-treatment-supports-art-for-all/
People who start antiretroviral therapy (ART) immediately after they are diagnosed with HIV, while their CD4 T-cell count is still high, have a lower risk of illness and death

https://www.poz.com/article/START-results-27299-8892
Gold-Standard Evidence Backs Early Treatment of HIV

http://www.medicalnewstoday.com/releases/285972.php?tw
"Delaying ART in patients with HIV reduces likelihood of restoring CD4 counts"

https://www.poz.com/article/Antiretrovials-Reduce-Cellular-Inflammation-Among-Elite-Controllers-of-HIV-23608-3878
Antiretrovials Reduce Cellular Inflammation Among Elite Controllers of HIV

https://www.poz.com/article/hiv-cardiovascular-elite-controllers-23015-5910
Cardiovascular Disease Risk Remains High in HIV Elite Controllers

"Elite Controllers Hospitalized More Often Than Those Treated For HIV"   
https://www.poz.com/article/elite-controllers-hospitalizations-26678-5093

Elite Controllers on average spent more than twice as many nights in hospital than people on ART, and about 50% more than people not on ART and with detectable viral loads. After adjusting for various differences between the EC and non-EC population, the study still found that ECs were 56% more likely to be admitted to hospital than people with undetectable viral loads on ART.

Elite Controllers Crowell TA et al. "Elite controllers" are hospitalized more often than persons with medically controlled HIV. Journal of Infectious Diseases, early online publication. doi: 10.1093/infdis/jiu809. 2014.

Karris MY and Haubrich RH. Antiretroviral therapy in the elite controller, justified or premature? Journal of Infectious Diseases, early online publication. doi: 10.1093/infdis/jiu812. 2014.

Cockerham LR and Hatano H. Elite control of HIV: is this the right model for a functional cure? Trends in Microbiology, early online publication. doi: http://dx.doi.org/10.1016/j.tim.2014.11.003.2014.

https://www.poz.com/article/life-expectancy-24972-2090 (With treatment)
Life Expectancy for Young People With HIV Is Nearly Normal

Starting HIV treatment soon after diagnosis may reduce the risk of developing HIV-related cancer by 74%
http://www.thebody.com/content/79258/starting-hiv-treatment-early-reduces-hiv-related-c.html

Starting HIV treatment soon after diagnosis may reduce the risk of developing HIV-related cancer by 74%, according to a recent study. However, starting treatment does not seem to lower the risk of developing cancer unrelated to HIV, the study finds. The data remained unclear on whether having an undetectable viral load helped reduce the risk of HIV-related cancers.

Researchers for the study, which was published Clinical Infectious Diseases, looked at data from the landmark START study, which was stopped early in 2015 because it found overwhelming evidence for the benefits of starting HIV treatment immediately versus waiting until CD4 counts drop.

https://www.poz.com/article/modern-progress-hiv-treatment-care-likely-adds-decade-life

the average age of death for a 20-year-old starting ARVs with a CD4 count greater than 350 during 2008 to 2010 was 78 years. This latter estimate is excellent news considering the recent push to get people with HIV on treatment as soon as possible after diagnosis, preferably with a CD4 count higher than 500.

The researchers believe that the continued improvement in survival during the first three years after individuals start ARVs has likely been driven by lower toxicities in modern treatments, improved adherence to treatment regimens, efforts to prevent other health conditions among people with HIV and better management of other health conditions that do arise.

July 10, 2017 - Even a Viral Load of 400 Six Months Into HIV Treatment Linked to a Higher Death Risk https://www.poz.com/article/even-viral-load-400-six-months-hiv-treatment-linked-higher-death-risk

A recent study found that those who achieved rapid viral suppression after starting antiretrovirals had a much lower long-term death risk.

People who do not promptly achieve viral suppression after starting antiretroviral (ARV) treatment for HIV are at a significantly higher long-term risk of death, aidsmap reports.

https://www.poz.com/article/primary-predictor-immune-recovery-cd4-count-start-hiv-treatment
Primary Predictor of Immune Recovery Is CD4 Count at Start of HIV Treatment
Starting treatment within four months of infection also predicted a better resurgence of CD4 cells

2018
https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciy362/4984654?redirectedFrom=fulltext

Neurological consequences of exposure to HIV without antiretroviral therapy

Conclusion
Subcortical atrophy and cortical thinning occur during untreated infection but may be arrested by cART. These findings emphasize the importance of early cART.


https://www.poz.com/article/hiv-quickly-starts-damaging-brain-treatment-halts-progression
HIV Quickly Starts Damaging the Brain, but Treatment Halts Progression
This finding adds yet more weight to the imperative of treating HIV as soon as possible after infection.

2017
https://www.poz.com/article/hiv-treatment-may-slow-brain-aging
HIV Treatment May Slow Brain Aging

2017
https://www.poz.com/article/treating-hiv-early-may-stop-viruss-damage-brain
Treating HIV Early May Stop the Virus’s Damage to the Brain

2018
Starting HIV Treatment With Higher CD4s Tied to Better Immune Rebound
https://www.poz.com/article/starting-hiv-treatment-higher-cd4s-tied-better-immune-rebound

2019
Starting HIV Treatment Very Early Offers Strong Benefits

A new analysis of the global START trial found that health outcomes were better for those starting treatment within six months.
https://www.poz.com/article/starting-hiv-treatment-early-offers-strong-benefits

2024:
“[T]he sooner ART is started after primary HIV infection diagnosis, the greater the chance of immune recovery”
https://www.poz.com/article/starting-hiv-treatment-early-leads-better-immune-recovery