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START
About the Trial
The Strategic Timing of Antiretroviral Treatment trial randomized 4,685 HIV positive adults with CD4 counts over 500 to immediate versus deferred therapy. Immediate treatment reduced serious AIDS events, non AIDS events, or death by 57 percent, with notably fewer cases of tuberculosis and cancers. The trial stopped early after 3 years. Before START, guidelines debated waiting until CD4 dropped below 350 or 500. After START, guidelines moved to recommend treatment at diagnosis. Earlier therapy also reduces the latent reservoir and inflammation. START completed the scientific case that HIV diagnosis equals treatment indication, the foundation of global elimination strategies.
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