January - March 2013
Earlier Antiretroviral Therapy in HIV – As Soon As Possible
Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain
Two recent reports in The New England Journal of Medicine have concluded that the best way to preserve the immune system, as assessed by measuring CD4+ T-cells, is to begin antiretroviral therapy as soon as possible after HIV diagnosis. In the SPARTAC trial (Filder, et al. N Engl J Med. 2013;368:207-17), the authors investigated the effect of a short course of antiretroviral therapy on the subsequent CD4+ T-cell decline in 366 adults with primary HIV infection. Patients were randomized to 12 or 48 weeks of therapy. In both arms, antiretrovirals were initiated within six months following HIV seroconversion. After an average follow-up of four years, only the group treated during 48 weeks experienced a significant benefit, with a reduction in the hazard ratio for the primary endpoint, which was the achievement of a CD4 count > 350 cells/μl.