Early versus deferred antiretroviral therapy initiation and long-term cardiovascular disease outcomes in people with HIV: The START study
Bibliographic record
Abstract
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/m2. Comorbidities included hypertension (19%), dyslipidemia (8%), diabetes (3%); 0.8% had a history of CVD. The median time to ART initiation was 2.5 years (interquartile range [IQR] 1.6–3.5 years) in the deferred arm and 7 days (IQR 2–17 days) in the immediate arm. Over the entire study follow-up period (median follow-up of 9.3 years), 71 participants (35 immediate, 36 deferred) experienced a CVD event with no difference in CVD event rates between the immediate and deferred arms (0.17 vs 0.17 per 100 person-years, respectively); these findings were consistent across the pre-2016 and post-1Jan2016 periods. There were 58 CVD events among males (33 immediate; 25 deferred) and 13 among females (2 immediate; 11 deferred). A possible benefit of immediate ART was seen in females but not males (Hazard Ratio = 0.19 [95% confidence interval: 0.04–0.86] vs 1.33 [0.79–2.24]; interaction P-value = .014), though numbers of events were low. 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".