The Evidence is In: Start HIV Treatment Early


If you are HIV positive and are thinking about starting treatment, there’s exciting news. The START study, the Strategic Timing of Antiretroviral Treatment, has been stopped early due to the finding that immediate treatment cut the risk of death and disease in half.

START was a randomised trial of 4685 HIV-infected people, which began in early 2009. Half the participants were put on therapy immediately, and the other half were offered treatment once their CD4 cell count dropped below 350. The study measured certain events – AIDS, serious non-AIDS ailments and death.

The trial was meant to run until the end of 2016, but the decision was made to end the trial early and offer treatment to all participants after it became evident that after an average of 3 years the treatment group had much lower rates of events. In fact there were 53% less events in the group who started treatment early, without any evidence of increased drug toxicities.

In the past it was often recommended that treatment be delayed until CD4 cells started decreasing, which was a sign of immune system destruction by the virus. However increasingly HIV doctors have been leaning towards earlier treatment, believing that it will lead to better outcomes for the patient. The guidelines on treating HIV in the USA and Australia reflect this belief. We now have the data to support this concept, and it also validates the push towards treatment as a prevention tool. Starting HIV treatment early not only benefits the community, it benefits the individual with HIV.

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