Leading HIV researchers and campaign groups have called for a dramatic change in how the virus is treated, after a study suggested that giving people drugs earlier meant a significant drop in early illness and death.
The British HIV Association (BHIVA) is expected to update its guidelines in light of “overwhelming evidence” produced by the strategic timing of anti-retroviral treatment study.
In the UK and other countries, including most of Europe, treatment is deferred, while it is given immediately in the US. But the study has found a 53% drop in serious illness and death if patients were given the drugs when they still had stronger immune systems.
The trial, involving 4,600 people, was stopped because of overwhelming evidence that HIV patients benefited if they were put on anti-retroviral treatment when their CD4 count (a measure of how well their immune system works) was above 500 rather than 350, as currently advised in the UK.
Dr Adrian Palfreeman, vice-chair of BHIVA, said his organisation would publish a review of its guidelines for anti-retroviral treatment within weeks. “Clearly, this study is going to massively affect our review,” he told the Guardian. “This is critical information which we just didn’t have yesterday and weren’t expecting until the end of 2016.”
Palfreeman said that infection prevention was a key motivator in changing the guidance. “One in four people with HIV do not know they are infected, and it may be deterring people from being tested if they feel like treatment will not start anyway, even if they do go to their doctor. Now we can say to people, you will start treatment as soon as you know your HIV status.”
The National Aids Trust and the Terence Higgins Trust have said they now hope funding will be made available so anti-retroviral drugs can be given at the point of diagnosis.
“These exciting results should dramatically change the approach to treatment for people living with HIV, both in the UK and internationally,” Deborah Gold, chief executive of the National Aids Trust said. “There is now clear evidence that starting treatment earlier is better for people’s health, as well as reducing the chance of the virus being passed on to others.”
Gold called on the NHS advisory bodies to “act quickly on these results and make sure that people living with HIV can access treatment as soon as they want to, given the significant health and prevention benefits”.
Dr Rosemary Gillespie, chief executive of the Terence Higgins Trust, called the research groundbreaking and said it added to the growing body of evidence that there should be no delay in treatment.
Gillespie said certain groups, including at-risk gay men could ask to start treatment earlier, but she wanted to see that treatment available to all. “The benefits to them and their partners outweigh the costs,” she added.
BHIVA is expected to make the case for funding in the strongest terms to the Department of Health. “To start treatment from the beginning of diagnosis for a person with HIV, every day for the rest of their life, is expensive, with drugs costing £5,000-£6,000 a year,” Palfreeman said. “The problem is that the Department of Health hasn’t got any money.
“That could change with the availability of generic drugs which could lower costs, although the drug companies are not going to like that.”
Anthony S Fauci – director of the National Institute of Allergy and Infectious Diseases, which is part of the National Institutes of Health that funded the trial – said the financial implications could be offset in the long-term as those infected with HIV became less likely to suffer severe ill health. “This is going to cost money if you have to go out and treat everyone who is infected … [but] there is no doubt that it is going to be less expensive to treat people early,” he said.
