Approaches To HIV Treatment In Africa And Europe Yield Similar Results

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Main Category: Public Health
Also Included In: HIV / AIDS
Article Date: 10 Jul 2008 - 0:00 PDT

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New research published in the open-access journal PLoS Medicine compares two different public health approaches to HIV treatment. The study authors find that the highly individualized approach to drug selection used in Switzerland is just as effective as the South African approach that used a limited number of drug combinations for all patients.

Antiretroviral therapy is the current treatment approach for about 3 million people with HIV in low- and middle-income countries. Most of these people are located in sub-Saharan Africa, where five years ago there were only about 50,000 people receiving the therapy. This six-fold increase in the past few years has led health professionals to question the World Health Organization's standardized approach to treatment selection and clinical monitoring: Can if be as successful as the individualized approaches used in resource-rich countries?

A team of Swiss and South African researchers tackled this question by analyzing and comparing two sets of data. The first sample consisted of over 2,000 patients enrolled in HIV treatment programs in two Cape Town, South Africa townships (Gugulethu and Khayelitsha) and the second consisted of over 1,000 patients enrolled in a nationwide study of HIV-infected persons called the Swiss HIV Cohort Study. The patients were all 16 years or older and had started antiretroviral treatment with at least three drugs since 2001.

The researchers concluded that the programmatic approach used in South Africa and the individualized Swiss approach were equally successful as long as treatment was provided in a timely manner. The difference in treatment regimens for HIV infection between the two countries was quite striking. In South Africa, patients would begin with one of four first-line therapies, and about 25% of them changed to a second-line therapy during the study period. Contrast this with Switzerland, a country that offered 36 first-line regimens and saw about 50% of patients switch to a new regimen during the study. Even with these different approaches to treatment, HIV-1 RNA (ribonucleic acid) levels decreased after one year of treatment in patients in both countries. Additionally, both countries saw about 25% of patients develop viral rebound - when viral levels increase after effective initial treatment - within two years.

One notable difference between the two countries, however, was the death rate (especially during the first three months of therapy), which was higher in South Africa than in Switzerland. The researchers suggest that the higher likelihood of South African patients to have advanced AIDS at the beginning of the study could account for this difference. Therefore, there may be gains in initiating therapy as early as possible in South African HIV patients as well as HIV patients in other resource-poor countries.

"A public-health approach to HAART [highly active antiretroviral therapy] provision using a limited repertoire of drugs and relatively few viral load measurements resulted in virologic treatment outcomes in townships in South Africa that were similar to outcomes in Switzerland. Our study also shows that many patients would benefit from earlier initiation of therapy, particularly in South Africa," conclude the authors.

Public-health and individual approaches to antiretroviral therapy: Township South Africa and Switzerland compared
Keiser O, Orrell C, Egger M, Wood R, Brinkhof MWG, et al.
PLoS Medicine (2008). 5(7): e148.
doi:10.1371/journal.pmed.0050148.
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About PLoS Medicine

PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org

About the Public Library of Science

The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org

Written by: Peter M Crosta
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