Universal early treatment for HIV could reduce mortality
Researchers estimated that universal early initiation of HIV treatment would have modestly reduced the elevated rate of death among people with HIV compared with the general population during a recent 18-year period.
“In earlier work, we saw that mortality among people with HIV was elevated above mortality in the general population and that this gap in mortality persisted into the most recent calendar period we examined, 2011 to 2017. We also know ART is effective to improve survival, especially when administered early,” Jessie K. Edwards, PhD, a research assistant professor of epidemiology at the University of North Carolina at Chapel Hill, told Healio.
“In this study, we looked at mortality among people with HIV had they been treated with ART within the first 3 months of entering HIV care to see if expanding access to early treatment would eliminate this elevation in mortality for people with HIV,” Edwards said.
Edwards and colleagues computed mortality over 5 years since entry into HIV care under observed treatment patterns for 82,766 adults entering HIV care at North American AIDS Cohort Collaboration clinical sites in the U.S. They compared the result with the mortality rate of similar individuals in the general population using the National Center for Health Statistics data.
During the study period, which ran from 1999 through 2017, the 5-year mortality rate among adults with HIV was 7.9 percentage points (95% CI, 7.6-8.2) higher than the expected mortality rate based on the U.S. general population. The study demonstrated that the elevation in the mortality rate for people with HIV would have been 7.2% (95% CI, 5.8, 8.6) under universal early treatment.
Additionally, the researchers found that in the most recent period assessed, 2011-2017, the elevation in the mortality rate for people with HIV was 2.6% (95% CI, 2, 3.3) under observed treatment patterns and 2.1% (95% CI, 0, 4.2) under universal early treatment.
“Starting treatment quickly after entering HIV care improves survival but is insufficient to eliminate the elevation in mortality for people with HIV,” Edwards said. “One reason may be that people often enter care well into the course of their disease — that is, with low CD4 cell count — such that treatment starts very late in the course of their disease, even if they are treated immediately upon entry into care.”