HIV-infected babies have a greater chance of survival if they receive treatment before they show signs of illness or a weakened immune system, the International Aids Society (IAS) was told on Tuesday.
A study of infants in Cape Town and Soweto, which began in 2005, found that 96% of infants given immediate drug treatment were still alive two years later, compared with only 84% of children given later treatment.
The study, by the United States National Institute of Allergy and Infectious Disease (NIAID), was so successful that it was cut short by four years so that all children could receive treatment.
An estimated 2,3-million children are currently HIV infected, with around 600 000 new HIV infections in children each year. Without treatment half of all babies infected with HIV die before their second birthday.
”Children with HIV infection frequently show rapid disease progression within the first year of life due to their developing immune systems and susceptibility to other serious infections,” said Dr Elias Zerhouni, director of the US National Institute of Health, in releasing the study at an IAS conference in Sydney.
”This is the first randomised clinical trial that shows that infants treated before three months of age will do better than infants who have their treatment delayed,” Zerhouni said in a statement.
The study of 337 babies aged 6 to 12 weeks was initially aimed at examining whether early antiretroviral drug therapy over a limited period would delay HIV progression.
Doctors had hoped that early treatment would allow a child’s immune system to develop and possibly allow the child to stop treatment for a period of time and avoid continuous therapy.
But a review in 2007 found such a significant difference in survival rates that the study was cut short and the results forwarded to the World Health Organisation.
”The results of this trial could have significant public health implications worldwide because these findings will cause experts to consider changes in standards of care in many parts of the world,” said NIAID director Dr Anthony Fauci.
Immune systems
Caring for HIV-infected children is complicated by the fact that their immune systems are not fully developed in the first year of life, which makes them especially susceptible to rapid the disease progression and death.
The current standard of HIV care in many parts of the world is to treat infants with antiretroviral therapy, but only after they show signs of illness or a weakened immune system.
Médécins Sans Frontières (MSF) said children were the ”silent victims” of the global Aids pandemic, with nine out of 10 child sufferers infected through mother-to-child transmission during pregnancy, childbirth or breastfeeding.
About 87% of children with HIV live in sub-Saharan Africa, with the vast majority beyond health services. Of the 540 000 children newly infected in 2006, 470 000 live in Africa and only 700 in either Europe or North America, said MSF.
MSF said ”vertical transmission” of HIV from mother to child had been almost been wiped out in wealthy countries because antiretroviral drug therapy was given to pregnant mothers and babies within a few hours of birth.
The mother-to-child transmission rate in wealthy nations was below 1%, compared with rates as high as 25% to 45% in poorer nations in Africa, said MSF.
The United Nations says close to 40-million people are infected with the Aids virus and that treatment had dramatically expanded from 240 000 people in 2001 to 1,3-million by 2005.
In June, world powers at the Group of Eight (G8) summit in Germany set a target of providing Aids drugs over the next few years to approximately five-million people. – Reuters