CROI 2015Beginning antiretrovirals (ARVs) for HIV when CD4s are higher than 500 significantly reduces the risk of major HIV-related illness and death when compared with delaying treatment, aidsmap reports. Researchers conducted a randomized controlled trial of 1,076 treatment-naive people with HIV in Ivory Coast who began the study with CD4s below 800 and who did not have active tuberculosis (TB). Results were presented at the 2015 Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle.

The participants were divided evenly into four groups, assigned to: start ARVs based on CD4 count, in accordance with levels set by the World Health Organization (WHO); start ARVs based on the WHO guidelines and also take daily isoniazid for six months as a preventive for TB; start ARVs immediately upon entering the study; or start treatment immediately and take isoniazid for six months. The WHO guidelines changed over the course of the study: From March 2008 to December 2009, WHO recommended starting treatment when CD4s dropped below 200. In December 2009 this figure changed to 350, and from July 2012 to the study’s end in December 2014 the figure was 500.

The participants had a median CD4 count of 465 when they started the trial. Forty-one percent of them had more than 500 CD4s at the study’s outset, 38 percent had between 350 and 500, and 21 percent had fewer than 350. They were followed for a median of 29 months. Fifty-eight percent of those in the arms set to wait for treatment until crossing WHO-defined CD4 levels qualified for treatment and started ARVs, a median of 14.8 months into the study. Ninety percent of those set to receive isoniazid began the preventive, and 94 percent of that group finished the prescription.

The researchers found that starting ARVs earlier led to a 44 percent reduced risk of serious HIV-related illness or death. (This figure would likely have been lower if the WHO guidelines throughout the study had recommended starting ARVs when CD4s reach 500 or below.) Taking isoniazid led to an independent 35 percent reduced risk of serious HIV-related illness or death.

To read the aidsmap story, click here. http://www.aidsmap.com/Starting-HIV-treatment-at-CD4-count-above-500-reduces-the-risk-of-serious-illness-and-death-by-44-African-Temprano-trial-shows/page/2948848/

To read the conference abstract, click here.

To watch a webcast of the conference presentation, click here.

To read a POZ/AIDSmeds feature on the debate over when to start treatment, click here.