Abstract
Evaluation of: Zolopa AR, Andersen J, Komarow L et al.: Early antiretroviral therapy reduces AIDS progression/death in individuals with acute opportunistic infections: a multicenter randomized strategy trial. PLoS ONE 4, e5575 (2009). The present study, also known as AIDS Clinical Trial Group (ACTG) A5164, was conducted to evaluate when antiretroviral therapy (ART) should be initiated in patients presenting with AIDS. Patients were randomized to receive ART immediately or after the completion of the treatment for the acute disease. The study indicates that immediate ART resulted in reduced AIDS progression and longer survival compared with deferred ART, with no increase in adverse events such as immune reconstitution syndrome or loss of virologic response. The main finding is that, in patients with advanced HIV disease, even 1 month of ART was sufficient for a difference to be observed between the two groups in terms of 1-year survival. This study has important clinical implications, even if it is not directly applicable to patients presenting with all AIDS-defining diseases. Indeed, patients with TB were excluded and most of the patients enrolled had pneumocystis and bacterial infections, while the other opportunistic infections were scarcely represented.
Published Version
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