Studies and Guidelines Continue to Support Earlier Antiretroviral Therapy, But. . .

Evidence continued to mount this year to support earlier initiation of antiretroviral therapy (ART) in a variety of settings. A randomized “when to start” trial in Haiti showed a fourfold increase in mortality risk among patients who started ART at CD4 counts ≤200 cells/mm³, compared with those who started ART between 200 and 350 cells/mm³ (JW Infect Dis Jul 14 2010). Two trials involving HIV-infected patients with tuberculosis (SAPiT and CAMELIA) demonstrated significant survival benefits for those who started ART early in the course of tuberculosis treatment (JW AIDS Clin Care Feb 24 2010 and Aug 9 2010). A study from British Columbia indicated that reducing the “community viral load” of the HIV-infected population via widespread provisio…