2. August 2005 09:00
Highly active antiretroviral therapy (HAART) for HIV-infected individuals has reduced the rate of progression to AIDS or death by 86%, according to new research from Bristol University published in The Lancet.
HAART is a combination of at least three antiretroviral drugs from at least two drug classes. Randomised trials of its effectiveness have only followed-up patients for a year or less. The effectiveness of HAART over several years has therefore been unknown until now.
Dr Jonathan Sterne of the Department of Social Medicine at Bristol University and colleagues studied over 3,200 patients from the Swiss HIV Cohort Study who had HIV but were free of AIDS when recruited to the study. A total of 400 of these patients subsequently progressed to AIDS or died.
The investigators compared HAART with no treatment in 2,161 patients and HAART with dual therapy (formerly the best treatment option) in 1,276 patients.
The analyses used new statistical methods that account for the fact that patients tend to be treated when their immune system becomes depleted by HIV, while they tend to remain untreated if their immune system is relatively intact.
The researchers found that, compared with no treatment, HAART’s effectiveness increased with time since initiation. However, HAART was found to be less beneficial for patients who were presumed to have contracted HIV via intravenous drug use than for other patients.
Dr Sterne said: “Our results indicate that HAART reduced the rate of progression to AIDS by 86%, and that its effectiveness compared with no treatment increased with time since initiation. These dramatic benefits put into perspective concerns about possible adverse effects of HAART. “
Professor Matthias Egger of the University of Berne, Switzerland, co-author of the study, added: “The very large benefits of HAART that are achievable in developed countries should remind us of the urgency of providing treatment for the millions of people who could benefit in other parts of the world, particularly sub-Saharan Africa.”
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