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At Last, Gold-Standard Evidence Backs Early Treatment of HIV

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We have always known that people lose CD4+ T cells to HIV. We know that higher CD4+ T cells is better than lower. The goal of treatment has always been to both prevent the loss of CD4+ T cells & raise the absolute level and percentage (to CD8+ T cells). HIV Clinical Trials have always looked at this in the context of various stages of disease. START looked at this from the beginning of infection. GOOGLE the UK CHIC study. Earlier treatment has always been better than later. Let's move on.

July 4, 2015 Chicago


It sure took a lot of research and thought to endorse treatment with drugs that broader society-and this very magazine-unequivocally endorsed for prevention. I think this study, and this very article, speak to a trend where the healthcare utilization of underprivileged and marginalized people is always scrutinized and must be justified. Meanwhile, the rich and privileged get immediate access, no questions asked. This whole study, up to this article and its incredulous tone, is vile.

June 8, 2015 Collinsville, IL


I am wary of the financial stakes behind early treatment and a fortiori behind PREP, and possible consequent manipulations of public opinion. The first part of this article contains enthusiastic phrases and loads of statistics on who was involved. We learn that "the other half were assigned to wait until their CD4s dropped to 350 or below, until they developed AIDS other serious illnesses..." (no comment). At last the results come, and they are much more mixed than the beginning suggests.

June 3, 2015

John Steven

I've benefited from early treatment. My HIV+ test was at age 62-now 64. My viral load was only 1064 (I did NOT leave out any zero's) and my CD4 960. I began treatment with Stribild immediately and was undetectable in 2 weeks. My current CD4 is 1684 and my CD4 / CD8 ratio is a near perfect 1.95 (2.00 being the textbook perfect ratio according to my doctor). I'm all in favor of early treatment. Mexico still waits to treat until the CD4 falls below 600. Will share this article w/ my docs here.

June 3, 2015 Mexico


This is not a gold standard at all! This is a further study that cheat trying to force people to start the treatment too early. What does it mean "The main reason those in the deferred group started treatment was because they fell below the 350 CD4 threshold"? The second arm trial should compare people taking antiviral as soon they fall below 500, (not 350) cd4 as state the WHO about starting the therapy. This study sucks because it just compare the early therapy with people that wait too long

June 2, 2015


One other thing. Why not mention TEMPRANO which was French led RCT that already presented their similar results at CROI. Feels like discovery of HIV competition to me to ignore that study and say START is the first...

June 2, 2015 SF


Nice article. The 18.4 bn figure is clearly wrong and reflects inflated costs for treatment which are really around 300 usd per person or around 11bn needed for everyone and we spend 20bn on everything now. Also France and other countries in Europe are doing test and treat like the US. It is incredible to see people fear mongering about forcing people to take treatment--only 50 percent of people living with HIV have access now--most only dream of the chance to get lifesaving meds!

June 2, 2015 San Francisco


I'm still dubious....all we have proven is that it's better to treat above 500 than to wait until a drop to 350. Treatment still needs to be weighed against resistance, kidney damage and the myriad other cons of long term use. I agree we likely have room for improvement but I'm still against blanket-treating t67 everyone as soon as we know they are poz. Seems more like an effort to use treatment as prevention than anything else.

June 1, 2015 San Diego


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