The START study
has accrued 2000 patients, halfway to its overall target of 4000. This marks an important milestone for the study, the findings of which could have wide-reaching implications for people living with HIV.
START (Strategic Timing of AntiRetroviral Treatment) is investigating the best time to begin treating HIV positive people with anti-HIV drugs known as antiretroviral treatment or ART.
START study participants are randomised into two groups. In the first, known as the EARLY group, patients begin antiretroviral treatment (ART) immediately. In the other group, known as the DEFERRED group, patients begin ART once their CD4+ cell count falls below 350 per millimetre cubed.
CD4+ cells are part of the immune system – when the immune system is strong, the CD4 count is higher but declines with time in people with HIV who are not taking anti-HIV drugs. Currently it is recommended that people with HIV start anti-HIV drugs when their CD4+ count drops to 350.
There is some evidence that HIV positive people who are not taking HIV medicines may have an increased chance of developing cancer or illnesses affecting the heart, liver or kidneys. However people who take anti-HIV drugs for a long time may have more side-effects or develop resistance to the anti-HIV drugs. It is therefore crucial to find out whether it is better to start taking HIV medicines as soon as it is known someone has HIV or to wait and follow the current guidelines. The results of the START study will be able to answer this question.
After a successful pilot phase, START has now expanded to over 230 sites in 35 countries. It is expected that recruitment will be completed by the end of 2012.