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The earlier you start ART the better the virologic control in HIV-infected infants.

By Junior Bazile Moderator | 06 Mar, 2017

There are some evidence coming from a randomized clinical trial in South Africa and other observational studies that indicate early initiation of ART in life reduces morbidity and mortality in HIV-infected infants. Fortunately, these findings have changed treatment guidelines that now advise imitation of ART irrespective of clinical and immunological status in all HIV infected infants and children.

Please read below the abstract of a research paper that was recently published and which looks into the issues mentioned above:

Abstract

Objective: The report of the 'Mississippi baby' who was initiated on antiretroviral therapy (ART) within 30 h of birth and maintained viral suppression off ART for 27 months has increased interest in the timing of ART initiation early in life. We examined associations between age at ART initiation and virologic outcomes in five cohorts of HIV-infected infants and young children who initiated ART before 2 years of age in Johannesburg, South Africa.

Methods: We compared those who initiated ART early (<6 months of age) and those who started ART late (6–24 months of age). Two primary outcomes were examined: initial response to ART in three cohorts and later sustained virologic control after achieving suppression on ART in two cohorts.

Results: We did not observe consistent differences in initial viral suppression rates by age at ART initiation. Overall, initial viral suppression rates were low. Only 31, 40.1, and 26.5% of early-treated infants (<6 months of age) in the three cohorts, respectively, were suppressed less than 50 copies/ml of HIV RNA 6 months after starting ART. We did observe better sustained virologic control after achieving suppression on ART among infants starting ART early compared with late. Children who started ART early were less likely to experience viral rebound (>50 copies/ml or >1000 copies/ml) than children who started late in both cohorts.

Conclusion: These findings provide additional support for early initiation of ART in HIV-infected infants

The full text can be found at this link:
http://www.medscape.com/viewarticle/875126?nlid=113124_724&src=WNL_mdplsfeat_...

Enjoy the reading.
Best,

Bazile

Replies

 

MICHELE HOLEVAR Replied at 11:50 AM, 9 Mar 2017

Thank you for providing the link to this article, which I believe may confirm many of our suspicions.

Junior Bazile Moderator Replied at 5:34 AM, 23 Mar 2017

Thank you Michele for your reply. I am glad that this link was useful to you. I hope that many of our community members found it useful as well.
Indeed, the earlier we start, the better it is.
All the best,

Bazile

Naphtal Nyirimanzi Replied at 6:05 AM, 23 Mar 2017

This is an interesting research finding.
However, in Rwanda; the Government is committed to global healthcare delivery, and now we are treating all people with HIV: "TREAT ALL" program, regardless their CD4 counts. This will reduce the morbidity and mortality, even new infections. The HIV incidence will decline overtime.
I think other countries would initiate the same program which will reduce the global burden of HIV/AIDS, hence contributing to the wellbeing of their citizens, and sustainable development.

Anup Chalise Replied at 9:05 AM, 23 Mar 2017

Thank you for the article. Let us hope that it can be put into practice all around the globe as soon. Putting it into practice will be a challenge in the parts of the world where evidence-based medicine has not, yet, taken a strong foot-hold.

Junior Bazile Moderator Replied at 6:36 AM, 30 Mar 2017

Thank you Naphtali and Anup for your contributions. I agree that "Treat All" is the way to go. The only issue could be enough resources but fortunately we have enough resources in this world to treat every single individual with HIV/AIDS.
I believe that even in the places where evidence-based medicine has not yet taken a strong foot hold, policy makers can be the game changers. Once the policies are changed it will remain important for big donors (PEPFAR, USAID, DFID, UNAIDS etc) to provide government, in countries with limited resources, with the necessary tools to implement those policies. There will also be need for in-country advocacy as well, for instance groups who believe in those policies should advocate at country level for the government to implement them.
Let's hope that we can eliminate HIV/AIDS in our lifetime.
Best,

Bazile

Eveline Melman Replied at 1:52 AM, 5 Apr 2017

treat all! and fast is my opinion too and test for cryptococcal meningitis in patients with a cd 4 below 100

Bikash Sah Replied at 11:23 PM, 11 May 2017

Dear Bazil,
Earlier I had mentioned about the questionnaire related to HIV testing that may help in increasing the rate of HIV testing. My article has been published. I am mentioning the link here: "http://www.anilaggrawal.com/ij/vol_020_no_001/papers/paper002.html" You had asked me for the questionnaire. Please go the link mentioned and give me necessary suggestions.
thanking you

edward shabani kateta Replied at 2:30 PM, 18 May 2017

Thank you for the updates...

Luunga Ziko Replied at 3:20 PM, 18 May 2017

How are your experiences with regard to HIV self testing using the oral
testing kit?

Junior Bazile Moderator Replied at 10:33 PM, 20 May 2017

Thanks a lot Bikash for taking the time to share your published questionnaire with this community. I like the approach taken focusing around the Belmont Report: respect for persons, beneficence and justice.
Have you been using this questionnaire? If yes, so far what type of interesting responses have you been getting?
Looking forward to hearing from you.
Keep up the good work.
Best,

Bazile

Bikash Sah Replied at 7:31 AM, 21 May 2017

Thank you, Dear Bazile. I have taken response just from medical and dental students of my institute. If you say, I can share that but it's still not the published work. I have submitted a proposal to take our institute faculties opinions on this questionnaire in our institute ethical committee. Once I get ethical clearance, I will take my institute health professionals and faculties opinion.

Thank You
Bikash

Junior Bazile Moderator Replied at 3:28 PM, 21 May 2017

Thanks a lot Bikash,
I really appreciate your sharing of your questionnaire with the community.
I will take some more time to look at the questionnaire and will get back
to you with questions/ comments.

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