The Treatment Action Campaign (TAC) has called on government to allow people living with HIV to start ARVS regardless of CD4 counts, following the release of several ground-breaking studies released yesterday.
Published in yesterday in the New England Medical Journal, the START trial followed about 4,700 people living with HIV in 35 countries for about three years. About half of these patients started ARV immediately regardless of CD4 count, which is a measure of the immune system’s strength. The other half could only start ARVs when their CD4 counts fell to 350 – in line with most national treatment guidelines at the time the study started in 2009.
The study found that those who started treatment early were 53 percent less likely to develop a serious illness or die.
“(The) START (study) provides compelling evidence that serious AIDS-related events like cancer and tuberculosis can be prevented by early treatment,” said the activist group in a statement released earlier today. “In the light of this, all HIV-positive people in South Africa should be recommended ARV therapy irrespective of CD4 count.”
In line with current World Health Organisation (WHO) guidance, South Africa requires people living with HIV to wait until their CD4 counts – a measure of the immune system’s strength – fall to 500.
South Africa may soon head activists’ calls
Signed by the heads of UNAIDS and the U.S. Presidents Emergency Plan for AIDS Relief, as well as prominent South African HIV researchers and others, the document calls for leaders globally to commit to immediate treatment for all people living with HIV – and for international donors to commit to funding this scale-up.
“ARVs have proven to be the only intervention that really reduces HIV transmission,” said CEO of the South African HIV non-profit the Right to Care Dr Ian Sanne. “(They) are still better than any other prevention intervention undertaken, this include microbicides, and they are better than condom use.”
While condoms are highly effective in prevention HIV transmission, multiple studies suggest that couples rarely use condom consistently.
According to Sanne, South Africa may already be preparing to heed activists’ calls. The government is currently investigating how much it would cost to offer people living with HIV ARVs immediately in an
approach that is often dubbed “test and treat.”
Viral load confirmed king
Also released yesterday, the HPTN 052 study confirmed that ARVs help slash aperson’s risk of transmitting the virus. Conducted among 1,760 couples in which one partner was HIV-positive, the study found that stable ARV patients who had very low levels – or “undectable” – of HIV in their blood were 93 percent less likely to transmit the virus.
These low levels of HIV are usually achieved after three months of daily HIV treatment, according to CEO of the South African HIV non-profit the Right to Care and HPTN 052 researcher Dr Ian Sanne.
About 75 percent of South Africa’s ARV patients have undectable viral loads, according to hundreds of thousands of viral loads processed monthly by the National Health Laboratory Services (NHLS), according to the NHLS Head of National Priority Programmes Unit Wendy Stevens.
Given the HPTN 052 study’s results and declining HIV viral loads in many communities, Stevens has suggested that the country may begin to see a reduction in HIV infections.
“South Africa is considering the test and treat strategy and, in principle, we will be moving towards test and treat,” Sanne said. “The idea is that we would require less laboratory monitoring (of CD4 counts)… there would be an overall simplification of the programme to being more people onto treatment quickly.”
Department of Health Deputy Director General Dr Yogan Pillay has already predicted that the WHO will recommend people be offered ARVs as soon as they are diagnosed in their next update of ARV guidelines expected in December. – Health-e News.