Early Antiretroviral Treatment Is Associated with Fewer Deaths

The optimal time for starting antiretroviral treatment in HIV-positive patients has always been unclear. In the absence of randomized controlled studies, guidelines that were based on imperfect data have tried to balance the large benefit of long-term treatment with its substantial toxicity. Two new studies argue for starting earlier in the course of infection than is usual practice now.

A U.S.-wide research consortium pooled outcome data on HIV-positive patients from 1996 (when potent combination treatment first became widely available) through 2005. Among 8362 patients with CD4⁺ cell counts of 351–500 cells/mm³, all-cause mortality was 69% higher in those who deferred antiretroviral treatment than in those who began treatment. Among 9155 p…