Evidence map›Paper›PMID 41018697›Full record

ArticleOpen forum infectious diseases2025

Early versus deferred antiretroviral therapy initiation and long-term cardiovascular disease outcomes in people with HIV: The START study.

Nila J Dharan, Shweta Sharma, Alejandro Arenas-Pinto, Daniel Duprez, Vicente Estrada, Karen Ha, Mariana Angelica Kundro, Rosie Mngqibisa, Henry Mugerwa, David Munroe and 7 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Open forum infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Nila J DharanTherapeutic and Vaccine Research Program, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.ORCID https://orcid.org/0000-0003-1175-5962
Shweta SharmaDivision of Biostatistics and Health Data Science, University of Minnesota, Minneapolis Minnesota, USA.
Alejandro Arenas-PintoMRC Clinical Trials Unit, University College London, London, UK.ORCID https://orcid.org/0000-0002-3368-5005
Daniel DuprezCardiovascular Division, Department Medicine, University of Minnesota, Minneapolis, Minnesota, USA.ORCID https://orcid.org/0000-0002-0993-6839
Vicente EstradaHospital Clinico San Carlos, IdiSSC, CiberInfec, Universidad Complutense, Madrid, Spain.
Karen HaDivision of Infectious Diseases, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey, USA.
Mariana Angelica KundroDivision of Emerging Diseases, JM Ramos Mejia Hospital, Buenos Aires, Argentina.
Rosie MngqibisaDurban International Clinical Research Site, King Edward Hospital, Enhancing Care Foundation, Durban, South Africa.ORCID https://orcid.org/0000-0002-6540-5733
Henry MugerwaJoint Clinical Research Centre, Kampala, Uganda.
David MunroeINSIGHT Community Advisory Board, Coordinating Centers for BioMedical Research (CCBR), University of Minnesota, Minneapolis, Minnesota, USA.
Rakan NasreddineDivision of Infectious Diseases, Saint-Pierre University Hospital, Brussels, Belgium.ORCID https://orcid.org/0000-0002-1265-1500
Tess E PetersonDivision of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.ORCID https://orcid.org/0000-0002-7223-651X
Irini SeretiDivision of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.ORCID https://orcid.org/0000-0002-0076-0224
Janine M TrevillyanDepartment of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.ORCID https://orcid.org/0000-0002-8660-5558
Jason V BakerDivision of Infectious Diseases, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.ORCID https://orcid.org/0000-0002-5542-1545
Gail V MatthewsTherapeutic and Vaccine Research Program, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia.
Andrew N PhillipsInstitute for Global Health, University College London, London  UK.ORCID https://orcid.org/0000-0003-2384-4807

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: It is unknown whether delayed antiretroviral therapy (ART) initiation worsens CVD outcomes in people with HIV (PHIV). This study compared CVD event rates between PHIV who were randomized to receive immediate versus deferred ART. Methods: ART-naïve adult PHIV with CD4+ counts > 500 cells/µL were randomized to immediate versus deferred ART initiation. Event rates for the main composite CVD outcome (myocardial infarction, coronary artery disease requiring revascularization, stroke and CVD-related death) were estimated for: (i) pre-2016 (treatment arms as designed); (ii) post-1Jan2016 (ART use similar across arms); and (iii) entire study follow-up period. Subgroup analyses were performed according to baseline characteristics. Results: Among 4684 participants (median age 36 years, 27% female, 30% Black race), 32% were smokers and 17% had a BMI ≥ 30 kg/m Conclusions: Early versus deferred ART initiation was not associated with reduced CVD events. The potential benefit associated with immediate ART in female participants warrants further evaluation.

Indexed as

antiretroviral therapycardiovascular diseaseHIV

Identifiers

PMID41018697
PMCPMC12461870

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.