Early treatment sees more HIV babies survive

HIV-infected babies have a greater chance of survival if they receive treatment before they show signs of illness or a weakened immune system, the International AIDS Society (IAS) was told on Tuesday. A study of infants in Cape Town and Soweto in South Africa found that infants given immediate drug treatment had a 96 percent survival rate compared with 84 percent for children where treatment was deferred.

The study, sponsored by the U.S. National Institute of Allergy and Infectious Diseases (NIAID), was so successful that it was amended in 2007, ending enrolments for the deferred treatment group and evaluating those in the group for treatment. An estimated 2.3 million children are currently HIV infected, with around 600,000 new HIV infections in children each year. Without treatment half of all babies infected with HIV die before their second birthday.

"Children with HIV infection frequently show rapid disease progression within the first year of life due to their developing immune systems and susceptibility to other serious infections," said Dr Elias Zerhouni, director of the U.S. National Institute of Health, in a statement on the study at an IAS conference.

"This is the first randomized clinical trial that shows that infants treated before 3 months of age will do better than infants who have their treatment delayed," Zerhouni said.

The study of 337 babies aged 6 to 12 weeks was initially aimed at examining whether early antiretroviral drug therapy over a limited period would delay HIV progression.

Doctors had hoped that early treatment would allow a child's immune system to develop and possibly allow the child to stop treatment for a period of time and avoid continuous therapy.

A review in 2007 found such a significant difference in survival rates and the interim results forwarded to the World Health Organisation.

"The results of this trial could have significant public health implications worldwide because these findings will cause experts to consider changes in standards of care in many parts of the world," said NIAID director Dr Anthony Fauci.

IMMUNE SYSTEMS

Caring for HIV-infected children is complicated by the fact that their immune systems are not fully developed in the first year of life, which makes them especially susceptible to rapid the disease progression and death.

The current standard of HIV care in many parts of the world is to treat infants with antiretroviral therapy, but only after they show signs of illness or a weakened immune system.

Medecins Sans Frontieres (MSF) said children were the "silent victims" of the global AIDS epidemic, with 9 out of 10 child sufferers infected through mother-to-child transmission during pregnancy, childbirth or breastfeeding.

About 87 percent of children with HIV live in sub-Saharan Africa, with the vast majority beyond health services. Of the 540,000 children newly infected in 2006, 470,000 live in Africa and only 700 in either Europe or North America, said MSF.

MSF said "vertical transmission" of HIV from mother to child had been almost been wiped out in wealthy countries because antiretroviral drug therapy was given to pregnant mothers and babies within a few hours of birth.

The mother-to-child transmission rate in wealthy nations was below 1 percent, compared with rates as high as 25 to 45 percent in poorer nations in Africa, said MSF.

The United Nations says close to 40 million people are infected with the AIDS virus and that treatment had dramatically expanded from 240,000 people in 2001 to 1.3 million by 2005.