Starting drug therapy early on for HIV patients
Posted on May 15, 2011
By Ashley Ahlholm, Institute for Health and Social Justice Program Assistant
On Thursday, April 12, 2011, results were released from a large multinational clinical study, HPTN 052, conducted by the HIV Prevention Trials Network that show a 96 percent reduction rate in transmission of HIV when antiretroviral therapy (ART) is initiated early.
The decision of when to start ART has been the subject of great debate in poor countries. The patient benefits are obvious, but these have been weighed against life-long cost of treatment and medications, and challenges to adherence. In Haiti, through the HIV Equality Initiative, Partners In Health and its Haitian sister organization Zanmi Lasante (ZL) began providing ART to people living with HIV in 1999. At that time, prevailing wisdom in public health claimed it was impossible to provide high-quality treatment and follow-up for people living with HIV in developing countries. But the success of ZL’s patients proved otherwise. For over eight years, Partners In Health has been providing HIV infected patients with free ART when the patient’s CD-4 count reaches 350 because it was the standard of care in the United States. PIH has gone on to implement successful, early initiation HIV treatment in Rwanda, Lesotho and Malawi. Once again, PIH has pushed the global health boundaries to extend the latest medical discoveries to the poorest patients around the world based on current science, not what was “acceptable” to implement in resource poor settings.
HPTN 052 is the first clinical trial to show how dramatically early ART affects transmission, and as such, should significantly shift the debate around and funding for HIV treatment and prevention policy.
In the study both groups received the same level of HIV-related care, including counseling on safe sex practices and regular HIV testing. The couples in the delayed ART group received traditional treatment, beginning ART when his or her CD4 count fell below 250 cells/mm3 or if he or she developed an AIDS-related illness. The participants in the early ART group received the same level of counseling, but started ART when they had a CD4 count between 350-550 cells/mm3. Among the 877 couples in the delayed treatment group, 27 HIV transmissions occurred. In contrast, only one transmission occurred in theearly ART group. This difference represents a 96 percent reduction in HIV transmission.
Partners In Health has always recognized that ART also results in a reduction of active tuberculosis cases among HIV infected patients. This study found that out of the originally HIV infected patients, 17 developed extra pulmonary tuberculosis in the delayed ART group, compared with three cases in the early ART group.
Treating people with HIV earlier can have a dramatic impact on their health, their partner’s health, and the epidemic as a whole. This is just one step in shifting the international lens of HIV treatment, we need to continue to advocate for ART as a solution to treating and preventing transmission of HIV and drastically reducing rates of tuberculosis.
