Over the past decade, evidence has been accumulating that starting potent combination anti-HIV therapy (commonly called ART) as early as possible in the course of HIV disease is beneficial. The evidence trend culminated in the summer of 2015 with the release of the results from the START clinical trial. In that large well-designed study, researchers were able to prove that starting ART early resulted in measureable benefit. Specifically, early initiation of ART reduced the risk of developing serious illness or death by more than 50% in people with no symptoms of HIV and who had relatively high CD4+ cell counts (more than 500 cells/mm3).
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Study Details
For this analysis the researchers made use of data accumulated by Canada’s national HIV observational database, called CANOC. This database collects health-related information from HIV-positive people from major clinics. The clinics remove any information that could be used to identify people from the data before it is sent to CANOC.
The researchers focused on data collected from three large provinces-British Columbia, Ontario and QuÂŽbec-with a total of 8,942 participants. At the time they entered the study, their average profile was as follows:
- age — 40 years
- 82% men, 18% women
- CD4+ count — 220 cells/mm3
- viral load — 80,000 copies/mL
Results
In the year 2000, the average CD4+ count at which a person started ART was 190 cells/mm3. By the end of 2012, the starting point had moved to 360 cells/mm3.