Official websites use. Share sensitive information only on official, secure websites. Department of Epidemiology, Harvard T. Department of Biostatistics, Harvard T. Clinical guidelines recommend immediate initiation of combined antiretroviral therapy ART for all HIV-positive individuals. However, those guidelines are based on trials of relatively young participants. The 5-year risk of all-cause mortality was 0.
The 5-year risk of non-AIDS mortality was 0. Immediate initiation appears to reduce all-cause and non-AIDS mortality in patients aged 50—70 years. Keywords: Aging, when to start, antiretroviral treatment, CD4 cell count, causal inference, parametric g-formula, comparative effectiveness.
As a result, clinical guidelines have been updated to recommend ART initiation in all HIV-positive individuals regardless of their CD4 cell count 3 — 5. However, these trials were comprised of relatively young participants median age 36 years and the number of deaths was too small to examine effects on mortality.
Thus, estimates of the impact of the new recommendations on mortality among older HIV-positive individuals, whose prognosis may be different, are currently lacking.
The number of patients diagnosed with HIV at older ages has increased over time 6. Compared with younger HIV-positive patients, those who enter HIV care at older ages are often diagnosed with late or advanced HIV disease 6 , have a diminished immunological response to treatment 9 — 11 , and are therefore at higher risk of progressing to AIDS or death. The clinical management of these patients is further complicated by a higher prevalence of comorbidities, including hyperlipidaemia, cardiovascular disease, cancer, and diabetes The benefits of immediate ART initiation might be partially or totally offset by polypharmacy, i.
