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How early to start: what do observational data suggest?

National and international guidelines on antiretroviral therapy for HIV infection recently changed to recommend earlier treatment, following the publication during 2009 of two collaborative analyses of HIV cohort studies [1, 2]. These studies used different methodologies, and reached different conclusions about the benefits of very early treatment. I will describe their methods, and possible reasons for differences in their results.


  1. Kitahata MM, Gange SJ, Abraham AG, NAACCORD Investigators, et al: Effect of early versus deferred antiretroviral therapy for HIV on survival. N Engl J Med. 2009, 360 (18): 1815-1826. 10.1056/NEJMoa0807252.

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  2. When To Start Consortium: Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies. Lancet. 2009, 373 (9672): 1352-1363. 10.1016/S0140-6736(09)60612-7.

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Sterne, J. How early to start: what do observational data suggest?. JIAS 13 (Suppl 4), O34 (2010).

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