This article previously appeared in aidsmap's HIV Update here.
Further findings from START, a major study which aimed to identify the benefits and harms of beginning HIV treatment at a high CD4 cell count, have recently been released. These findings concern cancer, heart disease and quality of life.
This study enrolled 4685 men and women with HIV who had never taken HIV treatment, were in generally good health and had a CD4 cell count over 500 cells/mm3. Based on random allocation, half the participants started HIV treatment immediately, while the other half deferred treatment until their CD4 cell count declined to 350 cells/mm3. As has already been reported, people who began HIV treatment immediately had a 57% reduction in serious illnesses and death.
Many of the serious illnesses that are prevented by prompt HIV treatment are cancers. A new analysis showed that HIV treatment has a particular impact on cancers which are linked to viruses and other infections, reducing them by 74%. Examples of these cancers are Kaposi’s sarcoma (linked to human herpes virus 8), Non-Hodgkin’s lymphoma (linked to Epstein-Barr virus), cervical cancer (human papillomavirus) and anal cancer (also human papillomavirus). HIV treatment also reduced the rate of cancers without infectious causes – such as prostate or lung cancer – by 51%.
However prompt HIV treatment did not make any difference to rates of heart attack and stroke, or an important early warning sign of heart disease (the elasticity of major arteries). When the START study was planned, many experts believed it would show the benefits of prompt HIV treatment in preventing heart disease, but in fact HIV treatment’s benefits have turned out to be different.
The question that still puzzles researchers is whether HIV-associated heart disease is primarily driven by the immune system being weakened (in which case, earlier HIV treatment should prevent heart problems) or by the immune system’s ongoing inflammation and activation as it attempts to deal with the infection (in which case, rates of heart disease may remain high in people living with HIV).
The study also found that rather than treatment side-effects having a negative impact on people’s quality of life when they start HIV treatment, quality of life actually improved. Study participants rated their own health-related quality of life on a regular basis with a range of questions, giving them the opportunity to note the impact of any drug side-effects, symptoms, pain or mood changes on their day to day life.
People who began HIV treatment said they had a better quality of life than those who were were not taking it. The difference was not large but it was statistically significant. The findings should provide reassurance to people who worry about HIV medications being ‘strong’, ‘toxic’ or causing more harm than good.