Improved quality of life with immediate versus deferred initiation of antiretroviral therapy in early asymptomatic HIV infection

Alan R Lifson, Birgit Grund, Edward M Gardner, Richard Kaplan, Eileen Denning, Nicole Engen, Catherine L Carey, Fabian Chen, Sounkalo Dao, Eric Florence, Jesus Sanz, Sean Emery, INSIGHT START Study Group

Research output: Contribution to journalA1: Web of Science-article

Abstract

OBJECTIVE: To determine if immediate compared to deferred initiation of antiretroviral therapy (ART) in healthy persons living with HIV had a more favorable impact on health-related quality of life (QOL), or self-assessed physical, mental, and overall health status.

DESIGN: QOL was measured in the Strategic Timing of Antiretroviral Therapy study, which randomized healthy ART-naive persons living with HIV with CD4 cell counts above 500 cells/μl from 35 countries to immediate versus deferred ART.

METHODS: At baseline, months 4 and 12, then annually, participants completed a visual analog scale (VAS) for 'perceived current health' and the Short-Form 12-Item Health Survey version 2 from which the following were computed: general health perception; physical component summary (PCS); and mental component summary (MCS); the VAS and general health were rated from 0 (lowest) to 100 (highest).

RESULTS: QOL at study entry was high (mean scores: VAS = 80.9, general health = 72.5, PCS = 53.7, MCS = 48.2). Over a mean follow-up of 3 years, changes in all QOL measures favored the immediate group (P < 0.001); estimated differences were as follows: VAS = 1.9, general health = 3.6, PCS = 0.8, MCS = 0.9. When QOL changes were assessed across various demographic and clinical subgroups, treatment differences continued to favor the immediate group. QOL was poorer in those experiencing primary outcomes; however, when excluding those with primary events, results remained favorable for immediate ART recipients.

CONCLUSION: In an international randomized trial in ART-naive participants with above 500 CD4 cells/μl, there were modest but significant improvements in self-assessed QOL among those initiating ART immediately compared to deferring treatment, supporting patient-perceived health benefits of initiating ART as soon as possible after an HIV diagnosis.

Original languageEnglish
JournalAIDS
Volume31
Issue number7
Pages (from-to)953-963
Number of pages11
ISSN0269-9370
DOIs
Publication statusPublished - 2017

Keywords

  • Journal Article

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