Every Now and Then, an Earth Shattering Trial with Immediate Implications for Policy

The CLAHRC WM Director has long thought that it made sense to treat all HIV patients with antiretrovirals and not wait until the CD4+ count had fallen to a specified threshold – a threshold that has been gradually increasing over the years. On this particular point, the Director was right. An RCT of 4,685 HIV-positive patients across 35 countries showed that immediate therapy, rather than therapy deferred until the CD4+ count had fallen below the current recommended threshold, reduced AIDS complications by over 50% within tight confidence intervals (P<0.001).[1] In addition, there is evidence that antiretroviral therapy can reduce the risk of HIV sexual transmission.[2]

— Richard Lilford, CLAHRC WM Director


  1. The INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015. [ePub].
  2. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011; 365: 493-505

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