Effect of immediate initiation of antiretroviral treatment in HIV-positive individuals aged 50 years or older. Journal of Acquired Immune Deficiency Syndromes
Clinical guidelines recommend immediate initiation of combined antiretroviral therapy for all HIV-positive individuals. However, those guidelines are based on trials of relatively young participants.
Lodi et al. on behalf of the HIV-CAUSAL Collaboration of HIV cohorts from Europe and the Americas aimed to estimate the 5-year risk of all-cause mortality and non-AIDS mortality among ART-naive, AIDS-free individuals aged between 50 and 70 years.
The study included 9’596 individuals (28% US Veterans) with median age of 55 (52–60) years and CD4 count of 336 (182–513) at baseline. The 5-year risk of all-cause mortality was 0.40% (95% confidence interval (CI): 0.10 to 0.71) lower for the general HIV population and 1.61% (95% CI: 0.79 to 2.67) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm3. The 5-year risk of non-AIDS mortality was 0.17% (95% CI: 20.07 to 0.43) lower for the general HIV population and 1% (95% CI: 0.31 to 2.00) lower for US Veterans when comparing immediate initiation vs initiation at CD4 <350 cells/mm3.
In conclusion, immediate initiation of ART seems to be beneficial in reducing all-cause mortality in AIDS-free patients aged 50 years or older, despite their low baseline CD4 count. More effort should be made into diagnosing HIV earlier, particularly in older patients to ensure timely initiation of treatment and follow-up for concomitant comorbidities, thereby maximizing the benefit of early treatment for HIV.