Early HIV Therapy Boosts Children's Survival

Treating babies soon after birth is clearly effective, African study finds

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By
HealthDay Reporter

WEDNESDAY, July 25, 2007 (HealthDay News) -- Starting anti-HIV treatment soon after birth is clearly the best means of ensuring infected children's survival, a new trial finds.

In fact, the African study was stopped four years early after researchers found that 96 percent of HIV-positive infants who received immediate treatment survived, compared to 84 percent of those who waited longer to get the drugs.

Currently, doctors in the developing world typically take the delayed approach, waiting until serious symptoms develop before prescribing medications.

That could all change, based on these findings.

"Young infants less than three months old, and maybe all those less than six months old, should start appropriate antiretroviral therapy right away," said Dr. Edward Handelsman, chief of the Pediatric Medical Branch of the U.S. National Institute of Allergy and Infectious Diseases (NIAID), which is overseeing the study.

The researchers were expected to present their findings Wednesday at the 2007 International AIDS Society Conference in Sydney, Australia.

An estimated 500,000 HIV-infected babies were born in 2006 worldwide. The new findings should not have much impact in the United States, where better prevention efforts mean that relatively few infants are born with HIV, Handelsman said. HIV-positive American infants usually get prompt treatment soon after birth, he added.

However, in other countries -- especially in the developing world where most infections occur -- resources remain limited. This is especially true of tests that are essential to determine if a baby is infected with the virus that causes AIDS. According to Handelsman, this means that anti-HIV treatment may only begin when infants start exhibiting medical problems.

The study, which began two years ago, sprang from the theory that it might be wiser to begin drug treatment much earlier, to allow the baby's own immune system to strengthen and grow. Once that happened, infants might avoid the need for lifelong AIDS medications -- a very expensive and onerous proposition.

Beginning earlier this year, 377 HIV-positive infants in South Africa -- aged between 6 and 12 weeks without serious signs of disease -- were each assigned to one of three groups as part of the study. One group was to receive treatment with AIDS drugs for 40 weeks, another for 96 weeks, and a third had their drug treatment delayed until symptoms appeared.

After analyzing results last month, researchers stopped the trial four years early, because the children's survival rates were so much better among those who received immediate treatment.

The researchers are examining whether those infants whose treatment has been delayed should get immediate treatment, as well.

Dr. Ram Yogev, an AIDS specialist and director of the Experimental Therapies Program at Children's Memorial Research Center, in Chicago, said he hopes the study findings will have an immediate effect on how doctors treat HIV-positive children. "Unfortunately, the need to start early treatment for every infected newborn will run into a lot of technical and economic problems," he said.

The most pressing concern is that diagnostic tests to confirm HIV infection are not cheap, and new technology is needed to make them less expensive, Yogev said.

More information

Learn more about HIV and children from the U.S. National Institute of Allergy and Infectious Diseases.

SOURCES: Edward Handelsman, M.D., chief, Pediatric Medical Branch, National Institute of Allergy and Infectious Diseases, Bethesda, Md.; Ram Yogev, M.D., director, Experimental Therapies Program, Children's Memorial Research Center, Chicago; July 25, 2007, presentation, International AIDS Society Conference, Sydney, Australia

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