Improved quality of life with immediate versus deferred initiation of antiretroviral therapy in early asymptomatic HIV infection. AIDS
Lifson et al. on behalf of the INSIGHT Start Study Group assessed if immediate compared to deferred initiation of antiretroviral therapy (ART) in healthy persons living with HIV had a more favorable impact on health-related quality of life (QOL).
Participants completed a visual analog scale (VAS) for ‘perceived current health’ and the Short-Form 12-Item Health Survey version 2 from which the following were computed: general health perception; physical component summary (PCS); and mental component summary (MCS); the VAS and general health were rated from 0 (lowest) to 100 (highest).
Mean baseline VAS and perceived general health scores were high with 80.9 and 72.5, respectively. Throughout follow-up, changes in all four QOL measures favored the immediate group (P<0.001). Estimated differences were as follows: 1.9 for the VAS, 3.6 for general health perception, 0.8 for PCS, and 0.9 for MCS. When QOL changes were assessed across various demographic and clinical subgroups, treatment differences continued to favor the immediate group.
In summary, in this large randomized clinical trial of ART-naïve patients from multiple countries who were in generally good health and who had above 500 CD4+ cells/ml at enrollment, there were modest but significant QOL improvements during follow-up in those immediately initiating ART compared to those who deferred treatment. The improvement in patient-perceived health with immediate ART adds to the growing body of evidence that supports recommendations to start ART as soon as possible after HIV diagnosis, irrespective of CD4þ cell count.