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A new study showed that giving immediate antiretroviral
therapy (ART) to HIV-infected infants for a limited time protected their immune
systems and delayed lifelong treatment. Infants who began ART must be treated
for life, but long-term ART increased the risk of drug resistance and toxicity.
The researchers determined they could stop treatment for a limited time and
spare the children some of the toxicity from ART.
Mark Cotton, a professor at South Africa’s Stellenbosch
University and co-leader of the study, and colleagues reviewed five years of
follow-up data from 377 HIV-infected infants. At 6–12 weeks, the infants were
selected randomly to begin short-term ART for 40 weeks or 96 weeks, or to wait
until showing signs of illness or a weakened immune system before receiving
ART.
Infants in the delayed treatment group started lifelong
treatment 20 weeks after the beginning of the study. Infants who received the
early 40 weeks of ART delayed restarting ART for an average of 33 weeks, while
those who completed the early 96 weeks of ART delayed restarting for an average
of 70 weeks. At the end of the trial, approximately 20 percent of infants given
40 weeks of early ART and one-third who received 96 weeks of initial ART were
well enough to avoid restarting lifelong treatment. The delayed group had a
significantly higher number of deaths and hospital admissions and higher
healthcare costs than the groups that received immediate temporary ART.
Study co-leader Dr. Avy Violari of the University of the
Witwatersrand in South Africa commented that early treatment followed by a
break was definitely better and more cost-effective than delaying ART, but the
researchers did not know whether a longer initial treatment period or early
continuous treatment would be more effective.
The full report, “Early Time-Limited Antiretroviral Therapy
Versus Deferred Therapy in South African Infants Infected with HIV: Results from
the Children with HIV Early Antiretroviral (CHER) Randomised Trial,” was
published online in the Lancet (2013; doi:10.1016/S0140-6736(13)61409-9).
