Tamar Kahn
26 July 2007
Sydney — Treating babies infected with HIV as soon as they are diagnosed rather than waiting until they show signs of illness dramatically increases their chances of survival, according to a South African study presented yesterday at the 4th International AIDS Conference on HIV pathogenisis, treatment and prevention.
The research could change the way doctors around the world care for the half a million HIV-positive babies born each year.
Despite the government's free programme for preventing mother to child transmission of HIV, at least 50000 infected babies are born in SA each year.
Local treatment guidelines say doctors should wait until HIV positive infants fall sick, or their immune systems show signs of weakness before starting lifelong antiretroviral treatment.
That may well change in the wake of the Children With Early Antiretroviral Therapy (Cher) study, which found that babies who were treated before three months of age did better than infants whose treatment was delayed.
Researchers found there were 75% fewer deaths among babies who got treatment immediately compared with those whose treatment was deferred.
The continuing study, funded by the US National Institutes of Health, had enrolled 377 babies by early this year . Ten of the 252 babies who got early treatment died (4%), compared with 20 of the 125 babies who started treatment only when they fell sick (16%). The babies were given a three-drug cocktail of AZT, 3TC and Kaletra.
"This is an overwhelming difference in survival among infants treated early," said the study's co-chair Avi Violari, head of the pediatric division of the Perinatal HIV Research Unit at the University of the Witwatersrand.
Scientists hoped that early treatment would slow progression of the disease, allowing babies' immature immune systems to develop, she said.
Once their immune systems were strong and could hold HIV at bay, the idea was to interrupt treatment and start again only when they showed signs of illness. This would hopefully allow children to avoid starting life-long medication at an early age, she said.
Dr Francois Venter, president of the Southern African HIV Clinicians' Society, said the study had broad implications for SA. "It may mean initiating treatment as soon as a diagnosis is made -- and that means SA has to get PCR (polymerase chain reaction) testing into every clinic," he said.
Babies born to HIV-positive women cannot be diagnosed with the widely available anti-body tests usually used for adults and children .
The Cher findings came to light last month after a routine review by the trial's independent data and safety monitoring board. The results led the researchers to stop the "deferred treatment" group, and offer all the babies immediate treatment.
Study co-chair Mark Cotton said: "The prevention of mother to child transmission programme is failing. It's a national disgrace."
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