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Saturday 10 October 2015

Studies support earlier HIV treatment

Posted in: International News, Health & HIV
By Daily News staff - 24th July 2015

Researchers and advocates say results from two landmark studies have bolstered the scientific case for initiating HIV treatment soon after diagnosis.

The studies have been presented at the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver.

“IAS 2015 will be remembered as the definitive moment when the world agreed earlier initiation of treatment is the best way to preserve the health of people living with HIV, and one of the best tools we have to slow HIV transmission to others,” says conference co-chair Julio Montaner, who is also the Director of the British Columbia Centre for Excellence in HIV/AIDS.

Montaner believes the new data will inform HIV treatment guidelines worldwide, and inspire governments, funders and health systems to act to save millions more lives.

For the first time, Jens Lundgren of the University of Copenhagen presented full results of the Strategic Timing of Antiretroviral Treatment (START) study, which was halted in May 2015 after preliminary data showed significant health benefits of earlier initiation of HIV treatment, regardless of the state of an individual’s immune health.

START is the first large-scale randomised clinical trial to establish that all people with HIV have a considerably lower risk of developing AIDS, and a lower risk of cancer, cardiovascular disease and other non-AIDS-related conditions, when they begin treatment right after diagnosis.

The researchers say the final results have important implications for the way HIV antiretroviral therapy is used worldwide.

"The data indicate that (early) treatment should be recommended for all HIV-positive people," Lundgren told a media briefing. "Of course the challenge now will be how to get the 20 (million) to 25 million people (worldwide) not on treatment yet, on treatment."

Myron Cohen of the University of North Carolina at Chapel Hill presented the final results of the HPTN 052 study, finding that the risk of sexual transmission of HIV was dramatically reduced for the duration of the ten-year study among individuals whose infections were well suppressed by therapy.

The study included 1,171 HIV serodiscordant straight couples in Malawi, Zimbabwe, South Africa, Botswana, Kenya, Thailand, Brazil and the US. Participants were randomly assigned either to start antiretroviral drugs right away, while their immune system was relatively healthy, or to delay treatment until their immune system weakened or they developed an AIDS-defining illness.

Researchers say starting antiretroviral therapy early reduced HIV transmission by 93 per cent over the course of the study. Eight cases of transmission occurred in partners of infected participants who received antiretroviral therapy – four of whom were diagnosed shortly after treatment began. Researchers says in those cases the virus was most likely transmitted just before antiretroviral therapy began, or right after, before treatment had fully suppressed HIV replication.

The other four infections occurred in study participants where treatment was no longer working and the virus was replicating.

Principal investigator Dr Myron Cohen of the University of North Carolina at Chapel Hill said researchers did not observe transmission when the HIV-infected partner's virus was "stably suppressed on antiretroviral therapy".

He said if people are taking their pills reliably and they're taking them for some period of time, the probability of transmission in this study is actually zero.

"Let me say it another way: We never saw a case of HIV transmission in a person who is stably suppressed on ART," he told the News and Observer.

The World Health Organisation says the evidence of the two clinical trials will play a significant role as it crafts updated HIV treatment guidelines.

We’ll have more on other research which has been presented at the conference soon

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