Giving antiretroviral therapy (ART) immediately after diagnosis for a limited period of time is more beneficial than postponing treatment in young infants infected with HIV, slowing progression of the disease and delaying the time to starting long-term ART, according to new research published in The Lancet.
"This important finding indicates we may be able to temporarily stop treatment and spare infants from some of the toxic effects of continuous ART for a while, if we can monitor them carefully", explains Professor Mark Cotton from Stellenbosch University in South Africa, one of the study leaders.
"With ART coverage in children currently at just 28%, our findings highlight the urgency of increasing early (within the first 3 months of life) testing and treatment of HIV-infected infants."*
Although giving early ART during infancy is beneficial and lifesaving, currently treatment must be taken for life and cumulative exposure increases the likelihood of drug-related toxicity and drug resistance.
In 2005, the children with HIV early antiretroviral (CHER) trial, funded by the US National Institutes of Health, and with participation of the Medical Research Council Clinical Trial Unit in London, randomly assigned 377 HIV-infected infants (between 6 and 12 weeks of age) from South Africa to one of three regimens: immediate protease inhibitor (PI)-based ART and continue for 40 weeks (ART-40W); immediate PI-based ART and continue for 96 weeks (ART-96W), with subsequent treatment interruption; or defer PI-based ART until signs of illness or a weakened immune system (ART-Def; standard practice).
In 2007, interim results reported that after a median of 48 weeks, giving immediate PI-based ART reduced the risk of death and disease progression by 75% compared with deferring ART until signs of illness or a weakened immune system.