START trial

Impact of early antiretroviral treatment on sexual behaviour: A randomised comparison

A strategy of early ART had no effect on condomless sex with HIV-serodifferent partners among MSM, but resulted in modestly higher prevalence among heterosexuals. However, among MSM and heterosexuals, early ART resulted in a substantial reduction in HIV-transmission-risk sex, to a very low absolute level.
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Which HIV-infected adults with high CD4 T-cell counts benefit most from immediate initiation of antiretroviral therapy? A post-hoc subgroup analysis of the START trial

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Yes
Author
Jean-Michel Molina, Birgit Grund, Fred Gordin et al.

Background

Immediate initiation of antiretroviral therapy (ART) in asymptomatic adults with CD4 counts higher than 500 cells per μL, as recommended, might not always be possible in resource-limited settings. We aimed to identify subgroups of individuals who would benefit most from immediate treatment.

Methods

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A randomized trial comparing concise and standard consent forms in the START trial

Is the resource available on the Internet?
Yes
Author
Grady C, Touloumi G, Walker AS, et al.

Improving the effectiveness and efficiency of research informed consent is a high priority. Some express concern about longer, more complex, written consent forms creating barriers to participant understanding. A recent meta-analysis concluded that randomized comparisons were needed.

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Effect of immediate initiation of antiretroviral therapy on risk of severe bacterial infections in HIV-positive people with CD4 cell counts of more than 500 cells per μL: secondary outcome results from a randomised controlled trial

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Yes
Author
O'Connor, Jemma et al.

The effects of antiretroviral therapy on risk of severe bacterial infections in people with high CD4 cell counts have not been well described. In this study, we aimed to quantify the effects of immediate versus deferred ART on the risk of severe bacterial infection in people with high CD4 cell counts in a preplanned analysis of the START trial.

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START analysis looks at who benefits most from immediate HIV treatment

Is the resource available on the Internet?
Yes
Author
Liz Highleyman

Starting antiretroviral therapy (ART) soon after HIV diagnosis led to better outcomes than delayed treatment in all population sub-groups in the START trial, researchers reported at the 21st International AIDS Conference (AIDS 2016) last week in Durban, South Africa. But some people saw greater risk reductions, including those over age 50, those with a lower CD4:CD8 ratio and higher viral load, and those with cardiovascular risk factors.

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