Serious Non-AIDS Conditions in HIV: Benefit of Early ART

Abstract

Data from the two trials demonstrated that initiating ART early in the course of HIV infection resulted in marked reductions in the risk of opportunistic diseases and invasive bacterial infections. This indicates that HIV causes immune impairment in early infection that is remedied by controlling viral replication. Intriguingly, in START, a marked reduction in risk of cancers, both infection-related and unrelated types of cancers, was observed. Like the findings for opportunistic infections, this anti-cancer effect of early ART shows how the immune system influences important pro-oncogenic processes. In START, there was also some evidence suggesting that early ART initiation preserved kidney function, although the clinical consequence of this remains unclear. Conversely, while no adverse effects were evident, the trials did not demonstrate a clear effect on metabolic-related disease outcomes, pulmonary disease, or neurocognitive function. HIV causes immune impairment soon after acquisition of infection. ART reverses this harm at least partially. The biological nature of the immune impairment needs further elucidation, as well as mechanisms and clinical impact of innate immune activation. Based on the findings from TEMPRANO and START, and because ART lowers the risk of onward transmission, ART initiation should be offered to all persons following their diagnosis of HIV.

Perfil epidemiológico de óbitos por HIV/AIDS na região nordeste do Brasil utilizando dados do sistema de informação de saúde do DATASUS

“…NEATON;2018). Assim, evitando o desenvolvimento da doença e suas complicações, como as infecções oportunistas levando ao óbito.…”

Impacto del Programa TARGA en la disminución de casos de sida en el sistema de salud peruano, 1983-2018

“…El impacto del Programa TARGA en el análisis de STI reveló que, por cada año transcurrido posterior a su introducción, ocurrió una disminución sustancial en los casos nuevos de 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 (13). Sin embargo, se ha ido adelantando su comienzo con cortes cada vez más altos de CD4 (350 y 500 células/mm 3 ) como se recomendó luego (17,18) a sabiendas de que el tratamiento universal reduce el riesgo de progresión de la infección (15). Esta forma temprana de tratamiento es el principal impulsor de la reducción de la morbilidad y la mortalidad por sida (16,17,19).…”

“…El inicio de TARV en un estadio avanzado se asocia con una mayor toxicidad medicamentosa y con el síndrome de reconstitución inmune (14). Sin embargo, el inicio del tratamiento se ha adelantado de manera progresiva, con recuentos cada vez más altos de T CD4 (350 y 500 células/mm 3 ), lo que reduce el riesgo de progresión de la enfermedad (15,16). Desde el 2016, la OMS recomienda el tratamiento universal a todas las personas con VIH cualquiera sea el recuento de CD4 (17).…”

Suppressive antiretroviral therapy associates with effective treatment of high-grade cervical intraepithelial neoplasia

“…It has been suggested that in the early stages of HR HPV-induced carcinogenesis the HR HPV-infected cells suppress acute inflammation in the epithelium, while later on HR HPVtransformed cells initiate chronic stromal inflammation, led by an increase of IL-6 158 . Meanwhile, as mentioned earlier, HIV-infection is associated with persistent immune activation and inflammation, illustrated by increased levels of immunologic biomarkers (such as IL-6) that remain increased even after ART is initiated, although at lower levels 28,[158][159][160][161] . Thus, HIV-induced inflammation, not only reduced CD4 counts, may play an important role in cervical cancer development in WLWH and this role may be diminished although not eradicated with suppressive ART.…”