Improved quality of life with immediate versus deferred initiation of antiretroviral therapy in early asymptomatic HIV infection

Alan R. Lifson, Birgit Grund, Edward M. Gardner, Richard Kaplan, Eileen Denning, Nicole Engen, Catherine L. Carey, Fabian Chen, Sounkalo Dao, Eric Florence, Jesus Sanz, Sean Emery, on behalf of INSIGHT START Study Group

Research output: Contribution to journalReview article

26 Scopus citations


Objective: To determine if immediate compared to deferred initiation of antiretroviral therapy (ART) in healthy persons living with HIV had a more favorable impact on health-related quality of life (QOL), or self-assessed physical, mental, and overall health status. Design: QOL was measured in the Strategic Timing of Antiretroviral Therapy study, which randomized healthy ART-naive persons living with HIV with CD4+ cell counts above 500 cells/μl from 35 countries to immediate versus deferred ART. Methods: At baseline, months 4 and 12, then annually, participants completed a visual analog scale (VAS) for perceived current health and the Short-Form 12-Item Health Survey version 2 from which the following were computed: general health perception; physical component summary (PCS); and mental component summary (MCS); the VAS and general health were rated from 0 (lowest) to 100 (highest). Results: QOL at study entry was high (mean scores: VAS=80.9, general health=72.5, PCS53.7, MCS=48.2). Over a mean follow-up of 3 years, changes in all QOL measures favored the immediate group (P < 0.001); estimated differences were as follows: VAS=1.9, general health=3.6, PCS=0.8, MCS=0.9. When QOL changes were assessed across various demographic and clinical subgroups, treatment differences continued to favor the immediate group. QOL was poorer in those experiencing primary outcomes; however, when excluding those with primary events, results remained favorable for immediate ART recipients. Conclusion: In an international randomized trial in ART-naive participants with above 500 CD4+ cells/μl, there were modest but significant improvements in self-assessed QOL among those initiating ART immediately compared to deferring treatment, supporting patient-perceived health benefits of initiating ART as soon as possible after an HIV diagnosis.

Original languageEnglish (US)
Pages (from-to)953-963
Number of pages11
Issue number7
StatePublished - Apr 24 2017



  • Antiretroviral therapy
  • Clinical trial
  • HIV
  • Mental health
  • Quality of life

Cite this

Lifson, A. R., Grund, B., Gardner, E. M., Kaplan, R., Denning, E., Engen, N., Carey, C. L., Chen, F., Dao, S., Florence, E., Sanz, J., Emery, S., & on behalf of INSIGHT START Study Group (2017). Improved quality of life with immediate versus deferred initiation of antiretroviral therapy in early asymptomatic HIV infection. AIDS, 31(7), 953-963.