Deferring ART Initiation in HIV-1 Linked to Worse Outcomes
(HealthDay News) — For individuals with HIV-1 infection, deferral of antiretroviral therapy (ART) beyond 12 months is associated with worse outcomes, according to research published online Nov. 24 in JAMA Internal Medicine.
Jason F. Okulicz, M.D., from the Uniformed Services University of Health Sciences in Bethesda, Md., and colleagues assessed participants in the observational U.S. Military HIV Natural History Study with documented estimated dates of seroconversion (EDS) who achieved virologic suppression with ART. The authors examined the impact of timing of ART relative to HIV-I infection on normalization of CD4+ T-cell counts, AIDS risk, and immune function.
The researchers found that among 1,119 HIV-1-infected participants, 38.4 percent of those initiating ART within 12 months and 28.3 percent of those initiating ART after 12 months from the EDS achieved CD4+ normalization (P = 0.001). Even among those participants with CD4+ counts of 500 cells/µL or higher at study entry and before ART, who had increased likelihood of CD4+ normalization, those initiating ART after 12 months from the EDS and study entry had significantly lower odds of CD4+ normalization (adjusted odds ratio, 0.20; P = 0.001). Lower risk of AIDS, reduced T-cell activation, and increased responsiveness of hepatitis B vaccine were seen with initiation of ART within 12 months of EDS versus later.
"Deferral of ART beyond 12 months of the EDS diminishes the likelihood of restoring immunologic health in HIV-1-infected individuals," the authors write.
Several authors disclosed financial ties to the pharmaceutical and medical device industries.