25 July 2007

HIV+ babies need drugs early

Evidence from South Africa announced at the International AIDS Conference shows that starting HIV-positive babies on treatment very young ups their survival rate dramatically.

Evidence from South Africa announced at the International AIDS Conference in Sydney shows that starting HIV-positive babies on treatment very young ups their survival rate dramatically.

Early results from the ongoing Children with HIV Early Antiretroviral Therapy (CHER) study have been released long before the trial’s completion, given their important bearing on the treatment of HIV-infected babies.

The CHER study, sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) and led by Avy Violari of the University of the Witwatersrand and Mark Cotton of the University of Stellenbosch, is the first of its kind to suggest that babies treated before three months of age will have a better chance against HIV/AIDS than those who receive treatment later.

“Initiation of ARVs commits to lifelong therapy,” said Violari, speaking at a late-breaker session at the AIDS Conference today.

Reducing the length of time spent on ARVs as far as possible is desirable because the life-saving drugs do have negative side effects. Also, they may not be easily accessible in resource-poor settings.

“The hypothesis of the study was that early limited ARV therapy until the child’s first or second birthday would delay disease progression and would involve less of a commitment to therapy.”

The CHER study enrolled 377 children from Soweto and Tygerberg Hospital, to evaluate the benefits of early antiretroviral (ARV) therapy given over a limited period in infants.

Two groups of children were to receive ARVs very young, one group for 40 weeks and the second group for 96 weeks; a third control group would only start treatment when doctors observed signs of progression towards AIDS.

The current treatment situation reflects the control group: HIV-positive babies are only started on ARVs when they show signs of illness.

After reviewing the early results last month, the trial’s data and safety monitoring board (DSMB) found a significant increase in survival of the babies who had received immediate ARV therapy.

Violari explained that HIV-positive infants are particularly vulnerable to rapid progression to AIDS, because their immune systems are immature in the first year of life.

“The highest number of deaths of babies in the study happened very early on,” said Violari.

And, there was a much higher death rate in babies from the control group who were not begun on early therapy.

The CHER study shows that starting ART in babies before the age of 12 weeks, instead of waiting for signs of disease to appear, reduces early mortality by 75%.

NIAID has released the early results of the study because these could have crucial public health implications, with experts needing to consider changes in how HIV-infected babies should receive treatment.

On the DSMB recommendation, no additional babies have been enrolled in the late-treatment control group of the study, and the parents of those previously enrolled in that group are being contacted to have their children evaluated for earlier treatment.

According to NIAID, over half a million babies worldwide were born last year with HIV.

- Olivia Rose-Innes, Health24, July 2007


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Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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