Sudha Seshadri.

M . Arfan Ikram, M.D., Sudha Seshadri, M.D., Joshua C. Bis, Ph.D., Myriam Fornage, Ph.D., Anita L. DeStefano, Ph.D., Yurii S. Aulchenko, Ph.D., Stephanie Debette, M.D., Ph.D., Thomas Lumley, Ph.D., Aaron R. Folsom, M.D., M.P.H., Evita G. Van den Herik, M.D., Michiel J. Bos, M.D., Ph.D., Alexa Beiser, Ph.D., Mary Cushman, M.D., M.Sc., Lenore J. Launer, Ph.D., Eyal Shahar, M.D., M.P.H., Maksim Struchalin, M.Sc., Yangchun Du, B.A., Nicole L. Glazer, Ph.D., Wayne D. Rosamond, Ph.D., Fernando Rivadeneira, M.D., Ph.D., Margaret Kelly-Hayes, R.N., D.Ed., Oscar L.

Benson, M.D., Ann C. Collier, M.D., Stephen E. Van Rompaey, Ph.D., Heidi M. Crane, M.D., M.P.H., Rosemary G. McKaig, Ph.D., Bryan Lau, Ph.D., Aimee M. Freeman, M.A., and Richard D. Moore, M.D. For the NA-ACCORD Investigators: Effect of Early versus Deferred Antiretroviral Therapy for HIV on Survival The use of antiretroviral therapy has dramatically reduced disease progression and death among patients with human being immunodeficiency virus infection,1,2 however the optimal time to begin with therapy is uncertain.3,4 Current guidelines recommend treatment for asymptomatic sufferers who’ve a CD4+ count of less than 350 cells per cubic millimeter based on accumulating observational data.5,6 However, these suggestions note the lack of data from randomized scientific trials relating to the timing of the initiation of antiretroviral therapy.3,4 Data from randomized trials are limited to an evaluation of a subgroup of 477 sufferers7 from the Strategies for Management of Antiretroviral Therapy trial ,8 which suggested that deferring antiretroviral therapy until the CD4+ count fell below 250 cells per cubic millimeter increased the risk of progression to the acquired immunodeficiency syndrome or death, as compared with initiation of therapy at a CD4+ count of more than 350 cells per cubic millimeter.7,9 Several observational studies have examined the prognosis for individuals who begin antiretroviral therapy at different CD4+ counts.5,6,10-16 However, these scholarly studies do not address the question of when to start out antiretroviral therapy, since they don’t have a comparison band of sufferers who deferred therapy.17,18 A few research have compared individuals with similar CD4+ counts who either deferred or initiated antiretroviral therapy, 19-24 but these studies did not have the statistical power and methods18,25,26 to examine differences in outcomes, particularly among patients with higher CD4+ counts.