Delaying the start of HIV treatment increases mortality

The study comes from an analysis of 22 cohort studies in the US and Canada.

The North American AIDS Cohort Collaboration on Research and Design focused on a group of patients with an intermediate CD4 T cell count, where the controversy has been the fiercest. US and European treatment guidelines strongly recommend that those with a count at 350 or below be started on a regimen, while those with a count above 500 had no need to do so. No conclusive data support starting treatment in patients with a count above 350, but some anecdotal evidence suggests that treatment may benefit those in the intermediate range.

The trial identified 2473 patients (8358 person years) who had begun treatment with HAART in the period 1996 to 2006 and an additional 5901 (16 636 person years) whose treatment was deferred in the same period, excluding those who had previously been on treatment or experienced an AIDS defining illness. The findings were clear: patients whose antiretroviral treatment was deferred had a mortality relative hazard 1.7 times that of patients whose treatment wasn't deferred.

"These data strongly support the use of antiretroviral treatment for patients at a CD4 count of 500 and below, regardless of the presence of symptoms," said the lead author, Mari Kitahata, from the University of Washington Center for AIDS Research.

In South Africa, the guidelines for starting are different because of the side effects of the limited treatment options available in the public sector, with patients starting lifelong treatment relatively late in the disease.