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Low-cost drugs package saves lives of people starting HIV treatment late
20 July 2017
Treating people who start HIV treatment late with a package of low-cost drugs to prevent serious infections saves three lives for every 100 people treated, according to the findings of a trial led by the Medical Research Council (MRC) Clinical Trials Unit at 香港六合彩.
The听results听from听the听REALITY听trial,听which听involved听1805 adults, teenagers听and children from Kenya, Malawi, Uganda and Zimbabwe听and听was funded by the MRC, the Department for International Development听(DFID) and听Wellcome,听are published听today in the听New England Journal of Medicine.
Current practice听in Africa听is to start听HIV听treatment听together with one antibiotic, cotrimoxazole,听to prevent a range of infections. But听when people start treatment
late,听HIV has听already caused severe damage to the听immune system听and patients have听very听low听numbers of听an important听blood cell听(called CD4 cells)听that fights听infections.听All听of听patients in the REALITY trial had听under 100听CD4听cells听per cubic millimetre of blood when the range in healthy people is between 500 and 1500.
The researchers recommend that people in Africa starting HIV treatment with low CD4 counts should be given the enhanced prevention package for the first 12 weeks of HIV treatment.
Around听one in five听people听starting HIV听medicines听in low-income countries have CD4听counts under听100听when they start treatment.听People living with HIV听with low听CD4 counts听are听at high risk of developing serious illnesses听after starting HIV treatment and around one in ten听will die听within the first听few听weeks of starting听treatment because their immune systems听cannot recover fast enough.
The REALITY trial looked at ways to reduce these deaths in the early stages of treatment. One of the strategies it tested was to prevent infections caused by bacteria and fungi by using an extra package of drugs including a TB drug (isoniazid), an antifungal (fluconazole), an antibiotic (azithromycin), and an anti-worm drug (albendazole), in addition to routine cotrimoxazole.
The听prevention听package of anti-infection听drugs听reduced听deaths and HIV-related illnesses.听Six months after starting HIV treatment, nine out of every 100 patients taking the extra anti-infection drugs had died, compared with 12 out of every 100 patients听taking听just听cotrimoxazole听and HIV treatment.听Thus the package saved听at least three lives听for every听100听people taking it, a relative reduction of 25%.
"Because many people with HIV in Africa do not start anti-HIV drugs听until their immune system has been badly damaged by the disease,听they听are at听a听high risk of dying within the first few weeks of treatment," explained Professor Di Gibb (MRC Clinical Trials Unit, 香港六合彩). "We听found that not only did this听additional听drugs package听prevent听early听deaths听among people starting听HIV treatment听with听low CD4 counts, but that it also reduced the听numbers of听severe AIDS illnesses听and听hospital听admissions."
Professor James Hakim from听the听University of Zimbabwe, said: "Another听important听result听we saw was that听although听the average CD4听count听among the 1805 people听starting treatment听in听REALITY听was only 36听cells per cubic millimetre,听which is very low,听half of them had听either听no听symptoms听or听only听very minor听ones. This shows the importance of measuring CD4 counts before starting HIV treatment, as there is no other way to identify many who would benefit from this package."
The drugs used in the enhanced听drugs听package are all relatively low cost.听The听total听cost ranged from听拢5听in Kenya to听拢26听in听Zimbabwe. Taking听the minimum drug costs across the countries involved in the trial, the听drugs听package was听about 拢4听more expensive than the standard听cotrimoxazole听drug costs听(拢4.34听vs听拢0.59).听Health economists听conducted听an听analysis听which听showed that听the package听was听highly听cost-effective听in all听of the听countries听involved in the trial.
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Source: Jon Rawlinson 听'Know your HIV status'听
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