UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

How have guidelines on when to start antiretroviral therapy affected survival of people living with HIV infection?

Rodger, AJ; Sabin, CA; (2016) How have guidelines on when to start antiretroviral therapy affected survival of people living with HIV infection? Current Opinion in HIV and AIDS , 11 (5) pp. 487-491. 10.1097/COH.0000000000000307. Green open access

[img]
Preview
Text
Rodger_How have guidelines on when to start antiretroviral therapy affected su.pdf - Accepted version

Download (449kB) | Preview

Abstract

Purpose of review: Until recently, conflicting data led to discrepancies in guideline recommendation on ‘when to start’ antiretroviral therapy (ART) in asymptomatic HIV infection. This review focuses on evidence underpinning guidelines over the past decade and recent randomized clinical trial data in this area, which definitively informed the debate. Recent findings: In 2015, the landmark START trial demonstrated clear clinical benefit in terms of a reduction in serious AIDS and non-AIDS-related events and death from any cause in HIV-positive individuals randomized to start ART with a CD4 count more than 500 cells/µl compared with deferring starting until CD4 count declined to 350 cells/µl. Further, randomized clinical trial data were also available from the Temprano trial in Côte D’Ivoire which also demonstrated a reduced risk of death associated with earlier ART initiation. Summary: Following the results of the START trial, guidelines that had previously set CD4 thresholds for treatment initiation were universally changed. This is likely to reduce mortality in people living with HIV who are diagnosed early and have immediate access to ART. However, unless HIV testing rates and ART coverage are increased globally, raising the threshold for initiation of ART in clinical guidelines may be of limited benefit in reducing mortality in HIV.

Type: Article
Title: How have guidelines on when to start antiretroviral therapy affected survival of people living with HIV infection?
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/COH.0000000000000307
Publisher version: http://dx.doi.org/10.1097/COH.0000000000000307
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Immunology, Infectious Diseases, ART, guidelines, mortality, when-to-start, SEXUAL TRANSMISSION, VIRAL LOAD, CD4 COUNT, HPTN 052, INITIATION, COHORT, TRIAL, IMMUNODEFICIENCY, METAANALYSIS, MORTALITY
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1511568
Downloads since deposit
141Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item