Irregular ART Use Increases Risk for HIV

Deferred or intermittent antiretroviral treatment (ART) increases an individual’s risk for AIDS-defining and serious non-AIDS-defining conditions, according to a new study.

To reach this conclusion, the researchers analyzed data from both the Strategies for Management of Antiretroviral Therapy (SMART) and Strategic Timing of AntiRetroviral Treatment (START) studies—2 global trials focused on HIV.

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The researchers compared the drug conservation arm in SMART and the deferred ART arm in START (deferred/intermittent ART group) with the viral suppression arms in SMART and the immediate ART arm in START (immediate/continuous ART group).

To assess the impact of deferred or intermittent ART usage, the researchers analyzed the incidence of AIDS, serious non-AIDS, cardiovascular disease, cancer, and death.

In all, 10,156 participants were included in the analysis. During 22,103 person-years of follow-up, there were 124 AIDS events (fatal or nonfatal); 247 serious non-AIDS or non-AIDS deaths; and 363 AIDS, serious non-AIDS, or death events.

Differences in CD4 cell count and viral suppression were similar between intervention groups. Because of this, the relative risk for AIDS and serious non-AIDS in each study was similar.

The researchers determined that a randomized strategy, consisting of deferred/intermittent ART, increased the hazard of AIDS by 3.6; serious non-AIDS by 1.6; and for the composite outcome of AIDS, serious non-AIDS, or death by 2.1 compared with immediate/continuous ART.

The underlying risk was greater in SMART than START, and because the hazard ratio in each was similar, the researchers determined that the absolute risk differences between treatment groups were greater in SMART than START.

“The impact of continuous ART in SMART and immediate ART in START in reducing the risk of infection-related cancer was significant and comparable between the 2 studies,” the researchers concluded. “Compared to a strategy of immediate/continuous ART, a strategy of deferred/intermittent ART, increased the risk of AIDS and SNA events among HIV-positive persons consistently in SMART and START.”

—Colleen Murphy

Reference:

Borges ÁH, Neuhaus J, Sharma S, et al. The effect of interrupted/deferred antiretroviral therapy on disease risk: a SMART and START combined analysis. J Infect Dis. 2019;219(2):254-263. https://doi.org/10.1093/infdis/jiy442.