The Effect of Interrupted/Deferred Antiretroviral Therapy on Disease Risk: A SMART and START Combined Analysis

The Journal of Infectious Diseases
Álvaro H BorgesSTART Study Groups

Abstract

Pooled data from the SMART and START trials were used to compare deferred/intermittent versus immediate/continuous antiretroviral therapy (ART) on disease risk. Endpoints assessed were AIDS, serious non-AIDS (SNA), cardiovascular disease (CVD), cancer, and death. Pooled (stratified by study) hazard ratios (HRs) from Cox models were obtained for deferred/intermittent ART versus immediate/continuous ART; analyses were conducted to assess consistency of HRs across baseline-defined subgroups. Among 10156 participants, there were 124 AIDS, 247 SNA, 117 cancers, 103 CVD, and 120 deaths. Interventions in each trial led to similar differences in CD4 count and viral suppression. Pooled HRs (95% confidence interval) of deferred/intermittent ART versus immediate/continuous ART were for AIDS 3.63 (2.37-5.56); SNA 1.62 (1.25-2.09); CVD 1.59 (1.07-2.37); cancer 1.93 (1.32-2.83); and death 1.80 (1.24-2.61). Underlying risk was greater in SMART than START. Given the similar HRs for each trial, absolute risk differences between treatment groups were greater in SMART than START. Pooled HRs were similar across subgroups. Treatment group differences in CD4 count and viral suppression were similar in SMART and START. Likely as a consequence, relati...Continue Reading

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Citations

Jul 23, 2018·The Journal of Infectious Diseases·Mark J Siedner, Virginia Triant
Jan 29, 2020·APMIS : Acta Pathologica, Microbiologica, Et Immunologica Scandinavica·Marinho Marques da Silva NetoÁlvaro H Borges
Aug 14, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Michael J SilverbergRomain S Neugebauer
Oct 7, 2019·Journal of Cancer Research and Clinical Oncology·Neval E WarehamJens D Lundgren

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