The benefit of starting antiretroviral treatment (ART) for HIV promptly has been a major theme of HIV research recently. START, a large and important study, conclusively demonstrated that by beginning HIV treatment early – when their CD4 cell counts are still high – people living with HIV (PLWH) can significantly reduce their risk of developing AIDS, other serious illnesses unrelated to AIDS, and dying. As a result, British treatment guidelines will suggest that HIV treatment should be recommended to all people living with HIV, whatever their CD4 count.

Now, another study has found that delaying ART may have especially serious consequences for middle-aged and elderly PLWH. Researchers looked at data on around 3500 Americans taking HIV treatment, with a particular concern for those people who died within ten years of starting treatment. This includes deaths from any cause, not necessarily related to HIV. As expected, people with lower CD4 counts (indicating a weakened immune system) had poorer outcomes. But this relationship was especially stark for those aged 45 to 64: 19% of those starting treatment with a CD4 count above 500 died, compared to 22% of those who started between 350 to 500, and 28% of those who started with less than 200. This suggests that starting ART as soon as possible is especially important for PLWH over the age of 45.

The full article can be read here.