ART in HIV-Positive Persons With Low Pretreatment Viremia: Results From the START Trial Article Swipe
Irini Sereti
,
Roy M. Gulick
,
Sonya Krishnan
,
Stephen A. Migueles
,
Adrian Palfreeman
,
Veronique Touzeau‐Römer
,
Waldo Belloso
,
Sean Emery
,
Matthew Law
·
YOU?
·
· 2019
· Open Access
·
· DOI: https://doi.org/10.1097/qai.0000000000002052
YOU?
·
· 2019
· Open Access
·
· DOI: https://doi.org/10.1097/qai.0000000000002052
Background: The benefit of immediate antiretroviral therapy (ART) at CD4 >500 cells/μL was established in the Strategic Timing of Antiretroviral Treatment (START) study. The benefits and risks of immediate ART in participants with low pretreatment viremia, including virologic suppressors, were further assessed. Setting: Randomized prospective international study. Methods: START participants with enrollment viremia <3000 c/mL were included. We compared clinical outcomes (grade 4 adverse events, hospitalizations, or death), plasma viremia, CD4 counts, and changes in biomarkers in immediate versus deferred ART groups. Results: Participants (N = 1134 including 93 with viremia ≤50 c/mL) had a median age of 37 years, 40% were women, and median CD4 was 713 cells/µL. Ninety-seven percent in the immediate and 29% in the deferred arm initiated ART at a median of 6 and 699 days, respectively. Clinical outcomes were experienced in 64 versus 61 patients in immediate and deferred arms (hazard ratio 1.10, 95% confidence interval: 0.77 to 1.56). The CD4 count difference was 125 cells/µL at 12 and 235 cells/µL at 36 months higher in the immediate versus deferred groups. D-dimer and VCAM levels decreased, and C-reactive protein increased, in the immediate arm at month 8. No significant changes in CD4 counts or biomarkers were observed in persons who maintained spontaneous virologic suppression. Conclusions: START participants with low enrollment viremia experienced higher CD4 counts, greater proportion with suppressed viremia, and decreases in D-dimer levels on immediate ART despite the lack of difference in serious clinical outcomes. These data support immediate ART in people with low viremia, although equipoise remains for suppressors.
Related Topics
Concepts
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1097/qai.0000000000002052
- OA Status
- green
- Cited By
- 13
- References
- 29
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W2940030007
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W2940030007Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1097/qai.0000000000002052Digital Object Identifier
- Title
-
ART in HIV-Positive Persons With Low Pretreatment Viremia: Results From the START TrialWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2019Year of publication
- Publication date
-
2019-04-11Full publication date if available
- Authors
-
Irini Sereti, Roy M. Gulick, Sonya Krishnan, Stephen A. Migueles, Adrian Palfreeman, Veronique Touzeau‐Römer, Waldo Belloso, Sean Emery, Matthew LawList of authors in order
- Landing page
-
https://doi.org/10.1097/qai.0000000000002052Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
-
greenOpen access status per OpenAlex
- OA URL
-
https://www.ncbi.nlm.nih.gov/pmc/articles/6607914Direct OA link when available
- Concepts
-
Viremia, Medicine, Hazard ratio, Confidence interval, Viral load, Antiretroviral therapy, Internal medicine, Prospective cohort study, Clinical trial, Human immunodeficiency virus (HIV), Immunology, GastroenterologyTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
13Total citation count in OpenAlex
- Citations by year (recent)
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2025: 1, 2024: 3, 2023: 3, 2022: 4, 2021: 1Per-year citation counts (last 5 years)
- References (count)
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29Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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