November 20, 2008
HIV-positive infants who begin receiving antiretroviral therapy immediately after being diagnosed with the virus are 76% less likely to die than HIV-positive infants who do not receive treatment until the disease has progressed, according to a study published Thursday in the New England Journal of Medicine, Reuters reports.
For the study, Avy Violari of the University of Witwatersrand in South Africa and colleagues assigned 377 HIV-positive infants to two groups. One group began antiretroviral treatment at about seven weeks of age, while the second group did not begin treatment until their CD4+ T cell counts dropped or they began showing symptoms of AIDS. Among the infants in the early treatment group, 4% died after 40 weeks of treatment, compared with 16% in the group that did not receive treatment until later (Emery, Reuters, 11/19). The study also found that early treatment reduced progression of the disease by 75%, from 26% in the late treatment group to 6% in the early treatment group (BBC News, 11/19).
The researchers halted the study early because the results were so conclusive and provided all infants in the study with antiretrovirals. In addition, the study led officials from Europe, the U.S. and the World Health Organization to recommend immediate antiretroviral treatment for HIV-positive infants.
Violari said the findings "reinforce the view that there are no reliable predictors" on disease progression for infants younger than age one and that CD4 counts do not determine with "enough accuracy" if infants "are becoming sick." The researchers were "alarm[ed]" at how fast the disease progressed in young infants, Violari said, noting that "some infants could seem fine in the morning and get sick and die by nightfall." She added that after analyzing the study data, it "became clear that treating all infants at the earliest opportunity after diagnosis was the best course of action" (BBC News, 11/19).
Violari said that it will take a "few years" to implement early HIV testing and treatment programs for infants because testing for infants is expensive and it will be difficult to identify HIV-positive infants in developing countries (Reuters, 11/19). Mark Cotton of the Comprehensive International Program of Research on AIDS said that implementing such programs will require "both manpower and resources."
Diana Gibb of the Medical Research Council in the United Kingdom said the No. 1 priority should be preventing mother-to-child HIV transmission. "The drug regimens are no picnic for these babies and even with improved outcomes in early life, there is still no cure for AIDS," Gibb said (BBC News, 11/19).
The study is available online.
Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2008 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.