Early versus deferred antiretroviral therapy initiation and long-term cardiovascular disease outcomes in people with HIV: The START study - Summary - MDSpire

Early versus deferred antiretroviral therapy initiation and long-term cardiovascular disease outcomes in people with HIV: The START study

  • By

  • Nila J Dharan

  • Shweta Sharma

  • Alejandro Arenas-Pinto

  • Daniel Duprez

  • Vicente Estrada

  • Karen Ha

  • Mariana Angelica Kundro

  • Rosie Mngqibisa

  • Henry Mugerwa

  • David Munroe

  • Rakan Nasreddine

  • Tess E Peterson

  • Irini Sereti

  • Janine M Trevillyan

  • Jason V Baker

  • Gail V Matthews

  • Andrew N Phillips

  • for the INSIGHT START Study Group

  • September 15, 2025

  • 0 min

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Objective:

To compare cardiovascular disease (CVD) event rates between HIV-infected individuals receiving immediate versus deferred antiretroviral therapy (ART) and to assess the impact of ART timing on these outcomes.

Key Findings:
  • 71 CVD events occurred (35 immediate, 36 deferred) with no significant difference in rates (0.17 vs 0.17 per 100 person-years). Subgroup analysis indicated a potential benefit of immediate ART in females (Hazard Ratio = 0.19) but not in males (Hazard Ratio = 1.33), highlighting the need for caution due to low event numbers.
Interpretation:

Early initiation of ART did not significantly reduce CVD events in the overall cohort, but the observed potential benefit for female participants warrants further investigation.

Limitations:
  • Low number of CVD events limits the robustness of subgroup analyses, and findings may not be generalizable to populations with lower CD4+ counts or different demographics.
Conclusion:

Immediate ART initiation does not appear to reduce long-term CVD events in HIV-infected individuals, though potential benefits in females warrant further study.

Original Source(s)

Early versus deferred antiretroviral therapy initiation and long-term cardiovascular disease outcomes in people with HIV: The START study

  • by Nila J Dharan, Shweta Sharma, Alejandro Arenas-Pinto, Daniel Duprez, Vicente Estrada, Karen Ha, Mariana Angelica Kundro, Rosie Mngqibisa, Henry Mugerwa, David Munroe, Rakan Nasreddine, Tess E Peterson, Irini Sereti, Janine M Trevillyan, Jason V Baker, Gail V Matthews, Andrew N Phillips, for the INSIGHT START Study Group

  • September 15, 2025

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