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Updated: Jun 8, 2026
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Rapid Screening of HIV Reverse Transcriptase and Integrase Inhibitors
Published on: April 9, 2014
When to start antiretroviral therapy.
1University of Washington School of Medicine, Seattle, WA, USA.
Summary
Starting antiretroviral therapy early for HIV, even with high CD4 counts, significantly reduces the risk of death. Deferring treatment increased all-cause mortality by 94% in a major study.
Area of Science:
- Infectious Diseases
- Immunology
- Public Health
Background:
- The optimal timing for initiating antiretroviral therapy (ART) in HIV management remains a long-standing debate.
- Limited randomized controlled trial data exist, necessitating reliance on observational studies.
- Emerging evidence highlights the detrimental effects of untreated HIV, including inflammation and immune activation.
Purpose of the Study:
- To evaluate the long-term outcomes of immediate versus deferred ART initiation in HIV-infected individuals.
- To address the controversy surrounding early versus late ART initiation based on CD4+ cell counts.
- To analyze data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) study.
Main Methods:
- Analysis of long-term outcomes from the NA-ACCORD observational cohort study.
- Comparison of mortality risks between immediate ART and deferred ART groups.
- Inclusion of asymptomatic, ART-naive individuals with CD4+ cell counts above 500/mm³.
Main Results:
- Deferring ART when CD4+ cell counts were greater than 500/mm³ was associated with a 94% increased risk of all-cause mortality.
- Modern ART demonstrates benefits in preventing both AIDS- and non-AIDS-related morbidity and mortality.
- Findings support earlier initiation of ART for improved patient outcomes.
Conclusions:
- Early initiation of antiretroviral therapy is associated with significantly reduced all-cause mortality in HIV-infected individuals.
- The risks of untreated HIV, including inflammation and immune activation, underscore the importance of timely treatment.
- Evidence from observational studies strongly supports initiating ART at higher CD4+ cell counts.
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