We have known for some time that HIV is doing damage from the moment the virus is contracted, but we’ve not always been clear about when it’s best to start treatment.
Since 2015, any doubts about the benefits of starting treatment were dismissed thanks to the findings of a study called the ‘Strategic Timing of Antiretroviral Treatment’ — or START.
The START study involved more than 4,600 people living with HIV from 35 countries. It looked at whether starting antiretroviral treament (ART) immediately was better for a person’s health than waiting until their CD4 cell count fell to 350, or they developed other illnesses.
Participants were aged 18 and older; about half were gay men and just more than a quarter were women. None of the participants had taken ART before and all had a CD4 cell count above 500.
While the START study was designed to end in December 2016, by May 2015 it had already established emphatically that starting ART early significantly lowered the risk of illness and death regardless of age, gender or CD4 count.
The START study confirmed that initiating ART as soon as possible is the best course of action for people living with HIV. Starting ART immediately is not only beneficial for our own health but it also means it’s possible to prevent the transmission of HIV to our sexual partners. Immediate treatment also puts us in the best position to take advantage of the next advance in drug therapy.
The Australian government has now removed restrictions on doctors prescribing ART. This means you can start treatment irrespective of your CD4 count. Before commencing treatment, however, there are a number of tests to go through: a drug resistance test, tests for potential allergic reactions to some drugs, an HIV viral load test and CD4 cell counts. The results will help determine the best drug combination to start on. This analysis takes time, but immediate treatment commencement for HIV can occur with starter medications and should not be delayed.
Read a blog article about immediate treatment and the results of the START study.