Comparative effectiveness of immediate antiretroviral therapy versus CD4-based initiation in HIV-positive individuals in high-income countries: observational cohort study. The Lancet HIV
Lodi et al. aimed to compare immediate initiation of antiretroviral therapy (ART) with strategies for starting ART based on CD4 thresholds of 500 cells/µl and 350 cells/µl in HIV-positive individuals from high-income countries. Median CD4 count at diagnosis of HIV was 376 cells/µl. Immediate initiation of ART increased survival and AIDS-free survival compared with initiation strategies based on CD4 count. However, compared with immediate initiation of ART, the mean survival time at 7 years was only 2 days shorter at a CD4 count less than 500 cell/µl and 5 days shorter at a CD4 count less than 350 cells/µl.
In conclusion, the benefits of a strategy of immediate ART initiation might be small in high-income settings with relatively low CD4 count at HIV diagnosis. A focus on better and innovative HIV testing strategies might be as important as discussions about early initiation of ART.