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AFRICA: Uninterrupted ART vital to longevity - new study

[This report does not necessarily reflect the views of the United Nations]

JOHANNESBURG, 24 January (PLUSNEWS) - Staying on antiretroviral therapy (ART) to keep viral loads low is better than taking structured breaks from the drugs, a study by the US's National Institute for Allergy and Infectious Diseases (NIAID) has revealed.

Treatment interruptions became a topic of much debate amongst HIV researchers after a handful of people who had previously taken anti-AIDS treatment maintained very low levels of viral load, even when they stopped their treatment.

Although antiretroviral medication improves the chances of living longer, the side effects and costs of the complex life-long regimes and the threat of drug resistance with long-term use has made doctors and patients look for alternative ways of using them, especially in developing countries.

"People would obviously prefer not to take a chronic medication every day," said Nathan Geffen, policy coordinator of South Africa's AIDS lobby group, the Treatment Action Campaign.

Questions arose as to whether strategically interrupting treatment would assist patients to adhere to the medication, and whether this approach would be more cost effective in humanitarian emergency settings.

But findings from a large-scale study, which began in January 2002 and recruited 5,472 volunteers in 33 countries, has dashed any hopes that this treatment strategy has any benefit.

The trials were based on the CD4 count (which measures the strength of the immune system) of volunteers, who were divided into two random groups. Those selected for episodic treatment would have to stop taking their medication once their CD4 count reached 350, but resume treatment if it dropped to 250. The other group took ART continuously to keep levels of the HI virus low.

CD4 cells help the body fight infection and their levels drop when they are under attack by the HI virus.

In January, after only two years of data had been collected, the US independent Data and Safety Monitoring Board (DSMB) evaluated interim study data and called a halt to further enrolments in the trials. They also suggested that participants in the episodic treatment section be put on continuous ART.

"The analysis revealed that participants on CD4 cell-guided episodic treatment faced more than twice the risk of disease progression relative to participants on continuous ART," NIAID said.

"Furthermore, there was an increase in major complications, such as cardiovascular, kidney and liver diseases, in the participants on the drug conservation arm. These complications have been associated with ART, and it was hoped that they would be seen less frequently in those patients receiving less drug," the institute noted.

Robin Wood, principal investigator for the South African leg of the trials, told PlusNews: "The study has been incredibly successful - it answered the question sooner than they thought it would have been. It has been one of the great successes."

But Wood pointed out that although a statistical risk of taking breaks had been proven, nobody on his programme got sick.

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