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A Conversation with Dr. Anthony Fauci: Results from the START Trial and Implications for the Global Treatment of HIV

Last week, NIH’s National Institute of Allergy and Infectious Diseases (NIAID) released the exciting results of the Strategic Timing of Antiretroviral Treatment (START) study, a randomized, controlled clinical trial to more clearly define the optimal time and benefits for people with HIV to begin antiretroviral therapy (ART).

Given the implications of the study, sat down with NIAID Director Anthony S. Fauci, M.D., to ask him about the study and what it means for the global treatment of people living with HIV. We also asked him to share his thoughts on the state of HIV treatment today.

The START trial enrolled 4,685 adults living with HIV infection in 35 countries. Funded by NIAID, along with a number of other NIH institutes and partners, the large-scale study found that there are significant health benefits for people with HIV to start ART sooner rather than later. The results support treating individuals  when their CD4+ T-cell count—a key measure of immune system health—is higher, instead of waiting until the CD4+ cell count drops to lower.

Previous evidence to support early treatment among HIV-positive people with CD4 counts above 350 was limited to data from non-randomized trials or observational cohort studies, and on expert opinion. START is the first large-scale randomized clinical trial to offer concrete scientific evidence to support the current U.S. HIV treatment guidelines, which recommend that all asymptomatic individuals with HIV take antiretrovirals, regardless of CD4 count.

“We now, for the first time, have an unequivocally solid scientific-based, evidence-based reason to recommend and support the treatment of HIV-infected individuals whose CD-4 count is greater than 500.” – Dr. Anthony Fauci

To learn more about the START study, see this blog post by Dr. Fauci. Also see this NIH news release announcing the results of the study.