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Sharma, Shweta; Schlusser, Katherine E.; de la Torre, Pola; Tambussi, Giuseppe; Draenert, Rika; Pinto, Angie N.; Metcalf, Julia A.; Neaton, James D.; Laeyendecker, Oliver (2019): The benefit of immediate compared with deferred antiretroviral therapy on CD4(+) cell count recovery in early HIV infection. In: Aids, Vol. 33, No. 8: pp. 1335-1344
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Abstract

Objective: To assess the impact of immediate vs. deferred antiretroviral therapy (ART) on CD4(+) recovery among individuals early in HIV infection. Design: Using serologic markers of early infection together with self-reported dates of infection and HIV diagnosis, ART-naive participants who were randomized to immediate vs. deferred ART in the Strategic Timing of Antiretroviral Treatment trial were classified into subgroups of duration of HIV infection at baseline. CD4(+) cell count recovery over follow-up according to duration of HIV infection was investigated. Methods: Three subgroups were defined: first, infected 6 months or less (n = 373);second, infected 6-24 months (n = 2634);and third, infected 24 months or longer (n = 1605). Follow-up CD4(+), CD8(+), and CD4(+) : CD8(+) ratio for the immediate and deferred ART groups were compared by subgroup using linear models. For the deferred ART group, decline to CD4(+) less than 350 cells/mu l or AIDS according to infection duration was compared using time-to-event methods. Results: Follow-up CD4(+) cell count differences (immediate minus deferred) were greater for those recently infected (+231 cells/mu l) compared with the two other subgroups (202 and 171 cells/mu l;P < 0.001). CD4(+) : CD8(+) ratio treatment differences varied significantly (P < 0.001) according to duration of infection. In the deferred ART group, decline to CD4(+) less than 350 cells/mu l or AIDS was greater among those recently infected (16.1 vs. 13.2 and 10.5 per 100 person years for those infected 6-24 and >= 24 months;P = 0.002). Conclusion: In this randomized comparison of immediate vs. deferred ART, the CD4(+) cell count difference was greatest for those recently infected with HIV, emphasizing the importance of immediate ART initiation.