Improved quality of life with immediate versus deferred initiation of antiretroviral therapy in early asymptomatic HIV infection

Abstract

Objective To determine if immediate compared to deferred initiation of antiretroviral therapy (ART) in healthy persons living with HIV (PLWH) had a more favorable impact on health-related quality of life (QOL), or self-assessed physical, mental and overall health status. Design QOL was measured in START (Strategic Timing of Antiretroviral Therapy), which randomized healthy ART naive PLWH with >500 CD4+ cells/μl from 35 countries to immediate versus deferred ART. Methods At baseline, months 4 and 12, then annually, participants completed a visual analogue scale (VAS) for “perceived current health” and the Short-Form 12-Item Health Survey version 2 from which were computed: (1) General health (GH) perception; (2) Physical Component Summary (PCS), and (3) Mental Component Summary (MCS); the VAS and GH were rated from 0=lowest to 100=highest. Results QOL at study entry was high (mean scores: VAS=80.9, GH=72.5, PCS=53.7, MCS=48.2). Over a mean follow-up of 3 years, changes in all QOL measures favored the immediate group (p<0.001); estimated differences were: VAS=1.9, GH=3.6, PCS=0.8, MCS=0.9. When QOL changes were assessed across various demographic and clinical subgroups, treatment differences continued to favor the immediate group. QOL was poorer in those experiencing primary outcomes; however, when excluding those with primary events, results remained favorable for immediate ART recipients. Conclusions In an international randomized trial in ART-naive participants with >500 CD4+ cells/μl, there were modest but significant improvements in self-assessed QOL among those initiating ART immediately compared to deferring treatment, supporting patient-perceived health benefits of initiating ART as soon as possible after an HIV diagnosis.

Providing antiretroviral therapy to all who are HIV positive: the clinical, public health and programmatic benefits of Treat All

“…Clinical and implementation research continue to provide important insights into the effectiveness of treating all persons living with HIV. Data from the START trial have found that immediate ART led to improved quality of life [15], and the programmatic benefits of early and rapid ART initiation in terms of reducing pre-ART loss-to-care can be substantial [13, 16,17]. Notwithstanding these benefits, there are important programmatic challenges to achieving the full benefits of Treat All.…”

Persons living with HIV with advanced HIV disease: need for novel care models

“…Among 305,443 PLHIV included in the analysis, 118,580 (38.8%) had a CD4+ ≥200 cells/mm 3 at ART initiation (median of 285 cells/mm 3 , interquartile range: 237 to 349 cells/mm 3 ) and the remaining 186,863 (61.2%) PLHIV had low CD4+ (<200 cells/mm 3 At 12 months after ART initiation, 21.3% (95% CI 21.1 to 21.6) of PLHIV with CD4+ ≥200 cells/mm 3 had been LTF or had died compared to 21.8% (95% CI 21.6 to 22.1) among those with CD4+ 100 to 199 cells/mm 3 , 27.3% (95% CI 26.9 to 27.7) among those with CD4+ 50 to 99 cells/mm 3 and 33.6% (95% CI 33.2 to 34.0) among those with CD4+ <50 cells/mm 3 ( Table 2). In multivariable models, compared to PLHIV with CD4+ ≥200 cells/mm 3 , those with CD4+ 100 to 199 cells/mm 3 had 9% increased risk of attrition (adjusted hazard ratio (AHR) 1.09, 95% CI 1.07 to 1.11), those with CD4+ 50 to 99 cells/mm 3 had 29% increased risk of attrition (AHR 1.29, 95% CI 1.27 to 1.32) and PLHIV with CD4+ <50 cells/mm 3 had 56% increased risk (AHR 1.56, 95% CI 1.53 to 1.58) ( Figure 1a, Table 3).…”

Psychological problems of HIV-infected patients in preparing to the start of antiretroviral therapy

“…АРВТ позитивно отражается на качестве жизни, что, в свою очередь, может улучшать психическое состояние, особенно при раннем начале АРВТ [13]. Если человек жалуется на тревогу или депрессию, ему следует обратиться к психиатру или психотерапевту.…”