Study Says HAART Slows HIV Progression to AIDS, But Success Threatened by Increasing Drug Resistance, U.K. Agency Says

Highly active antiretroviral therapy can slow the rate of progression from HIV to AIDS by 86% when compared with no treatment, according to a study published in the July 30 issue of the Lancet, Reuters AlertNet reports. Jonathan Sterne of the University of Bristol in the United Kingdom and colleagues examined the records of more than 3,200 patients who participated in the Swiss HIV Cohort Study after 1996, when HAART became available in Switzerland. Researchers compared disease progression among patients taking combinations of at least three drugs from two different classes, those taking two-drug regimens and those taking no drug therapy. The study found that the effectiveness of HAART increased over time, but HAART was less effective for patients who were thought to have contracted HIV through injection drug use (Reuters AlertNet, 7/28). "The very large benefits of HAART possible in developed countries provide a context for the debate about the relative cost-effectiveness of treatment compared with prevention in sub-Saharan Africa," the study says (Sterne et al., Lancet, 7/30). About one million of the six million HIV-positive people in developing countries who need lifesaving drugs are receiving the medications, according to the World Health Organization. Most of the approximately 39 million HIV-positive people worldwide live in sub-Saharan Africa (Reuters AlertNet, 7/28). In an accompanying editorial, Brian Gazzard of the Department of HIV at Chelsea and Westminster Hospital in London said the study highlights the fact that "[k]nowledge of one's HIV status can be lifesaving," and he urged health officials to make rapid tests widely available and performed by trained personnel. He also wrote that HAART should be made available to those who need it (Gazzard, Lancet, 7/30).

Drug Resistance
U.K. health experts on Thursday said that viruses are increasingly becoming resistant to the drugs used to treat them, BBC News reports. The government's Health Protection Agency and other organizations studied resistance to antiretroviral drugs among 4,450 HIV-positive patients for six years. They found that after two years on HAART, 10% of the patients had become resistant to some of the drugs, 20% had developed resistance after four years and 30% had become resistant after six years. Patients who develop HIV that is resistant to some drugs have less success with treatment (BBC News, 7/28). In Britain, about one in 25 HIV-positive people has a virus that is resistant to at least one drug in the three most common drug classes. In addition, about one-fifth of newly diagnosed patients are resistant to at least one antiretroviral, which experts believe might be because patients are contracting HIV from an HIV-positive person who is on antiretroviral treatment (Meikle, Guardian, 7/29). Peter Borriello, director of HPA's Centre for Infections, said scientists are trying to develop new antiretroviral drugs that can be used as second-line treatments for people who have drug-resistant HIV. Experts also are considering implementing routine aggressive treatment for HIV as soon as patients are diagnosed, even if a patient's immune status is good, he said. HPA Chief Executive Pat Troop also said the agency is working with countries where HIV is widespread to ensure that antiretroviral treatment programs do not lead to more drug-resistant virus (BBC News, 7/28).

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