Charles B. Hicks, MD reviewing Lifson AR et al. AIDS 2017 Apr 24.

Early versus deferred antiretroviral therapy improved self-assessed quality of life for healthy persons living with HIV.

To determine whether immediate or deferred antiretroviral therapy (ART) had a more favorable impact on quality of life in persons with early asymptomatic HIV infection, investigators conducted an international randomized study (START) involving 4561 healthy, ART-naive HIV patients with CD4 cell counts above 500 cells/µL.

Patients were randomized to receive either immediate ART or ART that was deferred until CD4 count fell below 350 cells/µL or until an AIDS-related condition requiring ART was diagnosed. Quality of life (QOL) was assessed using data from two patient questionnaires completed at baseline, 4 months, 12 months, and annually thereafter: the single-item visual analog scale and the Short Form 12-Item Health Survey, which included physical and mental component summaries.

During a mean 3-years of follow-up, comprising the blinded part of the study, changes in all QOL measures favored the immediate therapy group, a finding consistent across various demographic and clinical subgroups. QOL was poorer in persons who experienced serious AIDS or non-AIDS events or death from any cause (the primary endpoint of the study), but the results favored immediate initiation, even when such participants were excluded from the analysis.

CITATION(S):

Lifson AR et al. Improved quality of life with immediate versus deferred initiation of antiretroviral therapy in early asymptomatic HIV infection. AIDS 2017 Apr 24; 31:953. 

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