Early Treatment of All Persons with HIV Infection: From Immune Activation and Inflammation Studies to Randomized Clinical Trials

Treatment of people living with Human Immunodeficiency Virus (HIV) infection with antiretroviral therapy has dramatically reduced disease progression and death. There are strong supporting data and a public health argument that treatment prevents transmission of the disease. The optimal timing for starting antiretroviral therapy in asymptomatic people living with HIV infection was the subject of debate until 2015, when two large randomized studies (TEMPRANO and START) indisputably showed benefit of treating all people living with HIV regardless of CD4+ cell count. In this paper, we review the evidence from immune activation and inflammation studies to randomized clinical trials that supports early treatment of all asymptomatic people living with HIV regardless of CD4+ cell count, and we describe challenges and perspectives behind this strategy.