Early Initiation of Antiretroviral Therapy for HIV Infection Prevents Cancer

In a large randomized trial comparing immediate versus deferred antiretroviral therapy, the group that received immediate treatment had lower rates of infection-related cancers.

In the landmark START trial (NEJM JW Infect Dis Sep 2015 and N Engl J Med 2015; 373:795), more than 4600 HIV-infected patients with CD4 count >500 cells/mm³ were randomized to initiate ART immediately or to defer therapy until the CD4 count fell to <350 cells/mm³ or an AIDS-defining event occurred. In addition to reducing the overall rate of serious AIDS- and non–AIDS-related events, the immediate-ART group had a 64% lower cancer rate than the deferred group. Now, investigators have examined whether the effect of early ART on cancer was specific to infection-related cancers — which they hypothesized would be more sensitive to immune reconstitution — or to infection-unrelated cancers. Infection-related cancers were those linked to Epstein-Ba…

Reviewing Author

Rajesh T. Gandhi, MD

Disclosures

Grant/Research SupportNIH

Editorial BoardsUpToDate; ID Images (idimages.org); Infectious Diseases Society of America COVID-19 Treatment Guidelines; International Antiviral Society–USA (Guidelines Committee)

Leadership Positions in Professional SocietiesHIV Medicine Association; Infectious Diseases Society of America (Board of Directors)

Rajesh T. Gandhi, MD

Disclosures

Grant/Research SupportNIH

Editorial BoardsUpToDate; ID Images (idimages.org); Infectious Diseases Society of America COVID-19 Treatment Guidelines; International Antiviral Society–USA (Guidelines Committee)

Leadership Positions in Professional SocietiesHIV Medicine Association; Infectious Diseases Society of America (Board of Directors)

Early Initiation of Antiretroviral Therapy for HIV Infection Prevents Cancer

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Reviewing Author