START is a major study which aimed to identify the benefits and harms of beginning HIV treatment at a high CD4 cell count. As has already been reported, people who began HIV treatment immediately had a 57% reduction in serious illnesses and death. This has resulted in the guidelines for HIV treatment being re-written, with a recommendation that everyone who is able should start ART as soon as possible after diagnosis.

New findings from the START study concern cancer, heart disease and quality of life.

Many of the serious illnesses that are prevented by prompt HIV treatment are cancers. A new analysis showed that HIV treatment has a particular impact on cancers which are linked to viruses and other infections, reducing them by 74%. Examples of these cancers are Kaposi’s sarcoma (linked to human herpes virus 8), Non-Hodgkin’s lymphoma (linked to Epstein-Barr virus), cervical cancer (human papillomavirus) and anal cancer (also human papillomavirus). HIV treatment also reduced the rate of cancers without infectious causes – such as prostate or lung cancer – by 51%.

However prompt, HIV treatment did not make any difference to rates of heart attack and stroke, or an important early warning sign of heart disease (the elasticity of major arteries). This is a bit of a surprise, and the reason for it is not clear at present.

The study also found that rather than treatment side-effects having a negative impact on people’s quality of life when they start HIV treatment, quality of life actually improved. People who began HIV treatment said they had a better quality of life than those who were were not taking it. The difference was not large but it was statistically significant. The findings should provide reassurance to people who worry about HIV medications being ‘strong’, ‘toxic’ or causing more harm than good.