Published on August 23, 2013 at 9:18 AM
What is more, despite a longer period of continuous ART, the deferred treatment group had a significantly higher number of deaths, clinical events, and admissions to hospital, and was more costly than time-limited ART.
According co-lead author Dr Avy Violari from the University of the Witwatersrand in South Africa, “Early treatment followed by a break is definitely better and more cost-effective than delaying starting infants on treatment. But we do not know if a longer initial period of treatment, or early continuous treatment, might be even better.”
Writing in a linked Comment, Robert Colebunders from the University of Antwerp in Belgium and Victor Musiime from Makerere University College of Health Sciences in Kampala, Uganda, caution that little is known about the consequences of treatment interruptions and suggest that such a strategy may not be feasible in resource-poor settings such as Africa, where most children with HIV live, and where the availability of laboratories to monitor CD4 counts is limited.
However, they point out, “In the future, straightforward point-of-care tests…will probably become available for very early infant diagnosis. Together with new methods to monitor the infection, cessation of ART after a prolonged course of a highly effective treatment regimen could become an option…Indeed, if we were able to diagnose HIV infection in neonates very early and start ART shortly after birth, a prolonged period without ART, and perhaps even a functional cure in some children, can be expected.”