Cape Town - A major international clinical trial has found that HIV-infected people are at considerably lower risk of developing Aids and other serious conditions linked to the disease if they start antiretroviral (ARV) treatment early.
The randomised trial, which tested HIV-positive patients with a CD4 count of 500, found that the earlier initiation of treatment had substantial health benefits over those who start treatment when their CD4 count had dropped to 350.
As of January, SA started treatment once patients’ CD4 count dropped below 500, as opposed to 350, which had been the standard for some time now. The change brings South Africa in line with current World Health Organisation (WHO) HIV guidelines.
Last year, Health Minister Aaron Motsoaledi announced that as of January, HIV-positive pregnant women would be started on lifelong ARV treatment. Before that pronouncement, women with CD4 counts above 350 only participated in antiretroviral therapy until they stop breastfeeding.
The Strategic Timing of Antiretroviral Treatment (Start) trial, of which the Desmond Tutu HIV Centre was part, is the first large-scale randomised clinical trial to establish that earlier ARV treatment benefits all HIV-infected individuals. More than 4 600 men and women living with HIV were enrolled at 215 sites in 35 countries.
The study, which was conducted by the International Network for Strategic Initiatives in Global HIV Trials, took place over three years. It found that respondents had lower levels of serious illness. However, those who were initiated sooner had a clear further benefit. The rates of adverse events were similar in both groups, indicating that ARV therapy was safe.
Professor Robin Wood, managing director of the foundation, described the trial as encouraging.
“This is a very encouraging result that will inform policy, based on good-quality data. We now have strong evidence that early treatment is beneficial to the HIV-positive person,” he said.
The Desmond Tutu HIV Centre enrolled almost 300 patients in its study site, the largest number at any site. The trial was scheduled to close in December 2016 but a review by the study’s Independent Data and Safety Monitoring Board recommended that results be released early as the evidence was overwhelmingly in favour of early initiation of ARV therapy.
Eric Goemaere, senior HIV/TB adviser for Medecins Sans Frontieres said HIV funding and international commitment around HIV remained a challenge.
“The flatlining of HIV funding in recent years doesn’t bode well on the real commitment of the international community to end the pandemic,” he said.
“What is urgently needed now is investment and commitment to make the scale-up of the fight against HIV a reality, with a specific focus on the estimated 15 million people who don’t even know yet that they are living with the virus,” he said.