This is an excerpt from an article by Simon Collins that first appeared on TheBody.com here.
Have you heard of the START (Strategic Timing of Antiretroviral Treatment) study? In my opinion, it is probably the most important study currently running. It generates strong views, both for and against initiating antiretroviral therapy early, but the results are likely to be surprising.
Let's look at what START will and won't tell us about "when to start" treatment.
As an activist living with HIV, I want decisions about my care to be supported by evidence. Jumping ahead of the data -- even with the best intentions -- has led to treatment guidelines in the past getting it wrong. So, over the last five years, I have been surprised at how passionately some people object to START, already claiming to know the answers.
The big question from START is whether there are better health outcomes from starting antiretroviral therapy with a CD4 count above 500. This is compared to waiting until 350 -- a level at which we already know it is good to start.
No other randomized study had answered this.
And the answer to this question is not obvious. Here's why:
Even though many people already start treatment early and do well, people can reach "normal" life expectancy by just starting above 350. On the other hand, many people start far too late -- and if START shows benefits at very high CD4 counts, this could change guidelines globally.
Some questions in START are about fine tuning: Everyone in the study is lucky enough to have been diagnosed early and has access to antiretroviral therapy.
But START will also define the risks from earlier treatment. This includes direct risks such as side effects, which we expect to be low. It also includes long-term risks such as drug resistance. If earlier treatment has lower adherence rates, this might mean some people lose treatment options without any medical benefit.
To read the rest of the article go here.