As opportunities for HIV testing and access to treatment continue to become more available, it is important that all people involved in these efforts remember the following:
- HIV testing should always be offered and the many benefits of testing explained
Counselling is an important aspect of testing -- it is a chance to reinforce safer-sex behaviours and to help newly diagnosed people deal with the stress of a positive test result. Some newly positive people may not be aware of the massive changes in HIV treatment that have occurred in the past 30 years and the power and safety of potent combination anti-HIV therapy (ART). As a result, they may have concerns and questions that need to be addressed with brief education.
Although the results from START (and other studies) clearly show that immediate treatment of HIV is ideal both for the positive person and for society, some people may need a reasonable period of time after their positive test result to grapple with this development and realize that they generally have a long future ahead of them. However, the final decision to initiate ART should always be left to the person with HIV.
The most comprehensive HIV treatment guidelines are those produced by the U.S. Department of Health and Human Services (DHHS). Taking into account the results of START, the panel that writes the guidelines has made the following statement:
"The Panel continues to emphasize that patients starting ART should be willing and able to commit to treatment and to understand the benefits and risks of therapy and the importance of adherence. On a case-by-case basis, ART may be deferred because of clinical and/or psychosocial factors, but therapy should be initiated as soon as is feasible."
Another clinical trial called Temprano, which took place in Côte d'Ivoire, Africa, also compared early versus late HIV treatment. The findings from Temprano support those of START. Readers should note that neither START nor Temprano enrolled adolescents. However, the panel stated, "our recommendations have been extrapolated to adolescents based on the expectation that they will derive benefits from early ART similar to those observed in adults."
- Lundgren J, Babiker A, Gordin F, et al. The START study: design, conduct and main results. In: Program and abstracts of the 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention, 19-22 July 2015. Abstract MOSY0302.
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Statement by the DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents regarding results from the START and TEMPRANO Trials. 28 July 2015.