Important note: Information in this article was accurate in 2008. The state of the art may have changed since the publication date.

Reuters NewMedia - November 19, 2008
Gene Emery

BOSTON (Reuters) - Sooner is better when it comes to treating infants born with the AIDS virus, HIV, researchers reported on Wednesday.

A South African study of 377 babies found that giving newborns drug therapy right away, and not waiting until conventional tests showed a higher risk of becoming ill, cut the death rate by 76 percent.

When doctors withheld therapy until there were symptoms of AIDS or until immune system cells called CD4 T-cells dropped to low levels, the death rate was 16 percent, the researchers reported in the New England Journal of Medicine.

But among babies who began receiving treatment right away, typically around 7 weeks of age, only 4 percent died after about 40 weeks of care.

The leader of the study, Dr. Avy Violari of the University of Witwatersrand in Johannesburg, said the results have already prompted officials in the United States, Europe and the World Health Organization this year to recommend immediate treatment for infected babies.

Before then, doctors were advised to take an individual approach to care for infants, who are infected by their mothers during birth or while nursing.

"This was the landmark trial," Violari said in a telephone interview.

More than one-third of the deaths occurred at home, before caregivers realized something was wrong. Pneumonia and gastroenteritis were the chief causes.

"HIV attacked the developing immune system extremely quickly. The decline was so rapid, short of seeing the babies every day, you won't be able to pick up any meaningful changes that would prompt a doctor to start treatment," Violari said.

"The other thing is that the signs (of trouble) are so subtle, they don't give a good warning for the parent."

She said early testing for newborns is expensive and identifying infected babies will be a real challenge for developing countries.

"It's going to take a few years until early infant diagnosis is established," Violari said.

The study, known as the CHER trial, was designed to see if early HIV therapy would give the immune system time to develop and learn how to ward off the deadly illness.

The test was halted early because the results were so dramatic, and all the children who were not being treated were given HIV drugs.

The AIDS virus infects an estimated 33 million people globally. In 2007, 370,000 children became newly infected, and a total of 2 million are now infected with the deadly and incurable virus.

Drug cocktails can suppress the virus and keep patients healthy but they are expensive and difficult to get. There is no vaccine.

Giving the mother and baby HIV drugs around the time of birth can reduce transmission.

On the Net: New England Journal of Medicine

Reference: Early Antiretroviral Therapy and Mortality among HIV-Infected Infants Volume 359:2233-2244 | November 20, 2008 | Number 21

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