The future of ART
Living with AIDS 201

KHOPOTSO: People who are diagnosed early and have access to regular health care, monitoring and treatment of opportunistic ailments live longer, healthier, more fulfilling lives. Knowing their status also affords them the opportunity to make lifestyle choices that help delay progression to AIDS, thereby summarily suspending the need for antiretrovirals. But recent advances in medical research suggest that when someone is diagnosed within three to four months of having contracted HIV it could be beneficial to start them on treatment immediately. Norbert Tamm is study co-ordinator at Wits University’€™s Reproductive Health Research Unit.


The first three to six months of HIV infection (is) where we believe quite a lot of things are happening in the immune system; and possibly, quite important immune system functions are being destroyed, which people will need later on to maintain their immune system. What also happens in the body is that the immune system needs a little bit of time to start controlling the virus and in that time period the virus has a chance to multiply quite highly and actually do these destructions to the immune system. The idea is to give antiretroviral therapy for a limited period’€¦ to see if we can reduce the virus as soon as possible to possibly prevent some of these damages at the beginning of infection.        

KHOPOTSO: The Reproductive Health Research Unit is currently preparing a study,   called the SPARTAC study, aimed at researching the effectiveness of antiretrovirals during the first three to six months of HIV infection. Three sites ‘€“ one in Johannesburg as well as two in Durban and Mtubatubatuba in KwaZulu-Natal ‘€“ have been identified for the study, as part of an international research project that includes Russia and Australia. Preliminary results from a four-year pilot project involving over 100 people in the UK show that it is useful to start antiretrovirals almost immediately after infection.  


What we do know is that ARV treatment, for a limited period, at the time of sero-conversion doesn’€™t damage anyone; we know that it is safe to take it. The aim of the study is to show that the benefit is to strengthen the immune system in the long-term’€¦ We already have some preliminary data from the pilot study, but we need a bigger study to prove all those findings’€¦ A further benefit is the fact that at the time of sero-conversion the viral load goes very high; people are highly infectious to transmit the virus to others; they might carry on having unsafe sex because they’€™re not even aware yet that they might have become infected. So, anything to reduce that high viral load at the beginning of infection would hopefully, also reduce infection rates.

KHOPOTSO: Dr Francois Venter, is an HIV clinician at Johannesburg Hospital. Here are his thoughts on the study.


The annoyance for us as clinicians and as treaters is that the very cells which are supposed to be there cleaning up viral infections are the very ones which HIV attacks. The cells which are there to take out chicken pox, mumps, measles, rabies and all these other horrible diseases, are actually the ones which the HIV virus selects out, infects and damages’€¦ So, it’€™s quite a sneaky virus in that regard. Which is why treating during that phase makes sense, intellectually. The problem is that there are consequences to treating during that phase. You have, obviously, the potential drug resistance; you do have side-effects ‘€“ nobody wants to take tablets for nothing. We do not know if treating that phase actually will mean that that damage is less. It seems to make sense that it will be, but that there is a risk to taking these tablets. And I think that’€™s what this study is trying to do. It’€™s to try and show: Are the risks worth the benefits? We’€™re never going to get to know until we do it properly. And this is the first study I’€™ve seen that’€™s trying to do that.

KHOPOTSO: So, what are the criteria for eligibility to participate in the study? Norbert Tamm, again.  


Here, in Johannesburg, we’€™re also very much focussing on the gay community as well because’€¦ we want to make sure that the study has an all-inclusive approach and that people are aware of the options that they have’€¦ Here in South Africa, we’€™re looking for people who are 18 years or older. They must have either a negative HIV test within the last four to five months to be able to come into the study; we can otherwise do a quite intense assessment and possibly, run some other quite specific tests if they don’€™t have a negative test, so there is still a chance that we can include them into the study.            

For more information about the SPARTAC study you can call Norbert Tamm on

(011) 989-9260  

e-mail: Khopotso Bodibe                


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