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).