Two new studies conducted in South Africa, which suffers from an HIV epidemic, showed promise for immediate treatment, but highlighted the difficulties in carrying it out. The two studies actually had differing outcomes, which researchers at the International AIDS Conference said suggests that translating promising clinical results into real-world success is tricky.
One of the trials was randomized, offering immediate treatment. It found improvements in the results of individual patients but no differences in the HIV incidence in the HIV-negative population of the study. The other study, which also looked at immediate vs. deferred therapy, found that a 45 percent reduction in HIV incidence among people in the patient’s households could be achieved with early treatment, compared to those household members for whom therapy was delayed.
The randomized trial used home-based visits to find and test people in 22 rural communities near Durban. Those who tested positive for HIV were either offered immediate care or treatment, depending on which area they lived in. The strategy appeared to be feasible and well-accepted by the population. Even though there were some differences in how quickly people were treated, Francois Dabis, MD, PhD, of the Bordeaux School of Public Health, said that by the start of 2016 there was little difference found between the number of people on care and those with a fully suppressed viral load.
Dabis told MedPage Today that the researchers thought that the outreach would be good, which it was in the aspect that several thousand people learned their HIV status, and that many who were HIV-positive began treatment. However, by the start of 2016 there was little difference between the proportion of people with a fully suppressed viral load and those on care. There was also no significant difference in the rate of new HIV cases in the study population: 2.13 cases per 100 person-years in the treatment arm, 2.27 cases in the control arm.
Dabis said the lack of impact on the incidence of HIV cases suggests that a single approach, although good, is not sufficient. He said that one of the issues is that as much as 25 percent of the residents were not reached, mainly due to the migratory nature of the population.
Anton Pozniak, MD, PhD, of Chelsea and Westminster Hospital in London, said finding the people to test-and-treat can be very difficult. Often the people who are high-risk transmitters are not reached, so more people continue to be infected.
The second study included household members who had had at least two HIV tests and were HIV-negative when the treatment for the index patient was begun. The primary endpoint of the analysis was how many household members acquired HIV, but the researchers also analyzed the outcomes of the HIV-positive index patients.
The immediate-treatment patients had a 35 percent lower risk of death and a persistently better improvement in their CD4 cell count. In addition, the early treatment was associated with a 45 percent reduction of the risk of a household member acquiring HIV. Guy Harling, PhD, of the Harvard School of Public Health, said this is likely because of the benefit to sexual partners which is seen in clinical trials, during which the suppression of HIV nearly eliminates transmission to HIV-negative persons.
As in Dabis’ study, Harling’s group of researchers was unable to find a sizable portion of official residents in the region. However, both said that an important part of the response to the HIV/AIDS pandemic will be test-and-treat strategies, but acknowledged that other strategies are also needed.