Risk of severe bacterial infections including TB before and after immediate or deferred antiretroviral therapy: A multicenter, prospective, cohort study

Document Type

Article

Publication Date

7-1-2025

Publication Title

International journal of infectious diseases

Abstract

OBJECTIVES: Deferring ART until a CD4 count below cells/mm(3) or other clinical indication in people with HIV (PWH) carries an increased risk of severe bacterial infections and tuberculosis (TB). It is not known if this increased risk is reversed after ART initiation.

METHODS: We analyzed 4,684 adult PWH with CD4 cell counts above 500 cells/mm(3) who were randomized to immediate or deferred ART in the Strategic Timing of AntiRetrovial Treatment (START) trial. In May 2015, the deferred group was offered ART and follow-up continued until December 2021. Cox proportional hazards models were used to compare the risks of severe bacterial infections including TB in the immediate and deferred groups before and after ART initiation in the deferred group.

RESULTS: 217 (4.6%) participants experienced a severe bacterial infection during the entire follow-up period. Pre-2016, the immediate group had a lower rate of severe bacterial infections compared to the deferred group (HR 0.38; 95% CI 0.26, 0.55). During 2016-2021, there was no longer a statistically significant difference (HR 0.75; 95% CI 0.49, 1.16). No differences were observed between clinical or demographic subgroups.

CONCLUSION: The increased risk of severe bacterial infections seen after deferring ART is reversed once ART is initiated.

Medical Subject Headings

Humans; Male; Female; HIV Infections; Adult; Prospective Studies; Tuberculosis; Middle Aged; CD4 Lymphocyte Count; Bacterial Infections; Risk Factors; Anti-HIV Agents; Proportional Hazards Models; Anti-Retroviral Agents; Time-to-Treatment

PubMed ID

40268134

ePublication

ePub ahead of print

Volume

156

First Page

107911

Last Page

107911

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