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When to start treatment? The unanswered question of HIV research

1 Dec, 2011

To mark World AIDS Day 2011, Agnes Becker writes about the experiences of participants and staff of the SPARTAC study, an international HIV clinical trial funded by the Wellcome Trust.

In 2003 Rob was diagnosed as HIV positive. His blood tests showed he had only recently become infected with the virus. He was just one of the 33.4 million people around the world who were living with HIV at the end of 2008. By 2009, there were 2.6 million new HIV infections1. Although many countries still don’t have enough medicines treat all their patients, treatment is now available in most countries and has benefited millions of people globally.

Currently, one of the biggest questions in HIV research is whether treatment should be given to HIV positive patients earlier than current guidelines suggest. Under UK guidelines, Rob would probably not have been given medicines until his immune system, the part of the body HIV attacks, needed it – this can take as long as ten years. Starting treatment is a big decision as it can have negative side effects and needs to be taken every day for life.

Is early treatment better?

A huge amount of research has led to better drugs that have fewer side effects and, slowly, clinicians all over the world have begun to give their HIV patients treatment earlier than they used to. Treatment has also been shown to lower the risk of passing on the virus. If a person with HIV takes treatment as soon as they have become infected, could it stop HIV from replicating to high numbers and damaging the immune system? Could it also prevent the spread of HIV and help curb the epidemic?

Will people take treatment straight after becoming infected with HIV?

One of the main concerns is whether, among the mix of emotions of being diagnosed so close to the time of becoming infected, people would want to take treatment early. For Rob, finding out he was HIV positive early on was difficult as it meant he knew that at some point in the last few months he had been exposed to the virus.

During this difficult time, Rob consented to take part in the SPARTAC HIV clinical trial, a study looking at whether a short-course of treatment at this early stage of infection would benefit the immune system. Along with participants from across the world, he was randomly allocated to one of three treatment strategy groups – two groups were given either a 12 week or 48 week short-course of treatment and the third group was not given any early treatment, following current practice.

Nearly 250 participants were randomly assigned to the groups that received early treatment. At this time many of the participants felt well, as the virus had not had time to destroy the immune system enough to make them feel ill. Clinicians worried that perhaps because the participants didn’t feel sick it might stop them taking the medicines. Perhaps the prospect of taking drugs every day would be too daunting? Here’s what some the SPARTAC staff and participants thought:

The SPARTAC study results are soon to be published, yet one thing this study has shown is that by providing regular HIV testing, counselling and treatment, people living with HIV will take a short-course of treatment at the early stage of infection.

Future research

How will early treatment help the individual with their infection? What about preventing the spread of HIV? Is treating people early logistically or financially feasible? These questions are being explored by the next generation of clinical trials – it won’t be until we know their outcomes that we will know when is best to begin treatment.

Agnes Becker

Agnes is the communications contact for the SPARTAC study at Imperial College London.

The SPARTAC study  an international collaboration between leading research and academic institutions. You can find out more about it here.

Reference:

1. WHO Global Summary, 2009.

Image Credit: Wellcome Images

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