June 19, 2009
Geneva, Switzerland -- The International AIDS Society (IAS) today welcomed news from a clinical trial conducted in Haiti which supports mounting global consensus that HIV-positive patients in resource-limited countries are more likely to survive and experience less HIV disease progression if they start antiretroviral treatment (ART) earlier than currently recommended by the World Health Organization (WHO).
IAS President Julio Montaner explained that in developing countries ART is traditionally started once the patient's CD4 cell count -- a strong indicator of immune system strength -- falls below a measure of 200 cells/mm3. This is not the case in industrialized countries, where -- at the end of 2008 -- clinical guidance now suggests ART began no later than at a CD4 count of 350 cells/mm3.
"Though the HIV treatment landscape continues to evolve, WHO guidelines for low- and middle-income countries on when to initiate antiretroviral treatment have remained unchanged since 2006. While we recognize that the current economic environment is particularly challenging, our ethical obligation to improve and prolong life is far more urgent. Whilst people are needlessly dying of AIDS-related illnesses, guidelines must set out, in no uncertain terms, the quantifiable individual and public health advantages of starting many more people on HIV treatment earlier in order to help achieve universal access goals," said Dr Montaner.
"We are learning much more about when to start ART; when to substitute one treatment for another based on toxicity, virological or clinical failure; how to enable different levels of health-care workers to deliver care; how to improve patient monitoring and support services; and how to optimize the preventive benefits of ART. But ART is not a magic bullet that will alone curb the HIV pandemic. We must focus more on scaling up HIV testing, combining and tailoring prevention interventions to the specific needs of vulnerable populations with ART to keep people alive and well and prevent further infections. This can only be accomplished if laws and policies are put in place to protect and promote the rights of people living with HIV, women, children and the communities most vulnerable, particularly gay men and other men who have sex with men, people who inject drugs and sex workers. Treating and caring for more people earlier and more effectively needs to be our common global ambition," said Dr Montaner.
The study in Haiti was a randomized, controlled clinical trial carried out by the Haitian Group for the Study of Kaposi's Sarcoma and Immune Deficiency Disorders (GHESKIO) Centers in Port-au-Prince, Haiti. The principal investigator is Jean William Pape, M.D., the director of the GHESKIO Centers and a professor of medicine at Weill Medical College of Cornell University in New York. The U.S. National Institute of Allergy and Infectious Diseases (NIAID) is the study sponsor. The results show starting ART at CD4+ T cell counts of between 200 and 350 cells/mm3 improves survival compared with deferring treatment until CD4+ T cells drop below 200 cells/mm3.
Note to Journalists:
More information about the clinical trial in Haiti can be found at www3.niaid.nih.gov/news/QA/CIPRA_HT01_qa.htm and www.aidsmap.com/en/news/B4BEE942-4347-4FBB-87AC-38C654774959.asp.
More information about the preventive benefits of ART is available online at www.aids2008.org/admin/images/upload/785.pdf.