Some people who are diagnosed with HIV may be worried about starting antiretroviral treatment because of possible side effects or because of their fears of putting “strong,” perhaps “toxic,” chemicals into their body. Negative beliefs about antiretrovirals being dangerous or damaging medicines can cause some people to delay treatment until they feel it is “really necessary.” Some people have the mindset of waiting until their diagnosis gets worse in order to begin treatment.
However, at the annual Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, doctors and researchers discussed the importance of beginning treatment early regardless of CD4 count. Rather than any potential side effects of treatment having a negative impact on people’s quality lives, they used the Strategic Timing of AntiRetrovial Treatment Study (START) to show that people who began treatment early had a significant improvement in the quality of their lives than people who waited until their CD4 count dropped.
The study began in 2011 and enrolled over 4,500 adults, all who entered the trial with a CD4 count above 500 cells/mm3. Over the years, the study started to add more participants, eventually reaching over 14,000 people. Nearly a third started ART with a CD4 count of 250-350 cells/mm3, while eight percent started once they fell below 250 cells/mm3.
The findings of the study show that HIV causes persistent immune system damage right after infection and indicate that ART should be provided for everyone immediately regardless of CD4 count. The START participants who started treatment immediately saw benefits regardless of sex, age, ethnicity or geographic region.
Based on the findings, researches concluded that we could not rely on CD4 count to fully capture immune deficiencies in early HIV infection. "This trial demonstrates that even in people with high CD4s, there's a hole in the immune system if you're HIV-positive," The main researcher of the study explained.
ART is able to fill the gaps in the immune system at least partially, but even fully suppresses therapy may not be able to completely reverse immune damage once it's done, which is why it’s important to start treatment early before that damage can take place. Researchers added that it will be important to develop new types of treatment beyond ART aimed at restoring lost immune function.
