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Current HIV/AIDS Reports
Published in: Current HIV/AIDS Reports 2/2018

01-04-2018 | Co-infections and Comorbidity (S Naggie, Section Editor)

Serious Non-AIDS Conditions in HIV: Benefit of Early ART

Authors: Jens D. Lundgren, Alvaro H. Borges, James D. Neaton

Published in: Current HIV/AIDS Reports | Issue 2/2018

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Abstract

Purpose of review

Optimal control of HIV can be achieved by early diagnosis followed by the initiation of antiretroviral therapy (ART). Two large randomised trials (TEMPRANO and START) have recently been published documenting the clinical benefits to HIV-positive adults of early ART initiation. Main findings are reviewed with a focus on serious non-AIDS (SNA) conditions.

Recent findings

Data from the two trials demonstrated that initiating ART early in the course of HIV infection resulted in marked reductions in the risk of opportunistic diseases and invasive bacterial infections. This indicates that HIV causes immune impairment in early infection that is remedied by controlling viral replication. Intriguingly, in START, a marked reduction in risk of cancers, both infection-related and unrelated types of cancers, was observed. Like the findings for opportunistic infections, this anti-cancer effect of early ART shows how the immune system influences important pro-oncogenic processes. In START, there was also some evidence suggesting that early ART initiation preserved kidney function, although the clinical consequence of this remains unclear. Conversely, while no adverse effects were evident, the trials did not demonstrate a clear effect on metabolic-related disease outcomes, pulmonary disease, or neurocognitive function.

Summary

HIV causes immune impairment soon after acquisition of infection. ART reverses this harm at least partially. The biological nature of the immune impairment needs further elucidation, as well as mechanisms and clinical impact of innate immune activation. Based on the findings from TEMPRANO and START, and because ART lowers the risk of onward transmission, ART initiation should be offered to all persons following their diagnosis of HIV.
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Metadata
Title
Serious Non-AIDS Conditions in HIV: Benefit of Early ART
Authors
Jens D. Lundgren
Alvaro H. Borges
James D. Neaton
Publication date
01-04-2018
Publisher
Springer US
Published in
Current HIV/AIDS Reports / Issue 2/2018
Print ISSN: 1548-3568
Electronic ISSN: 1548-3576
DOI
https://doi.org/10.1007/s11904-018-0387-y

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