Lusaka study: Starting antiretroviral treatment keep patients coming back

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Science Speaks is in Atlanta, Georgia this week and will be live-blogging from the 20th CROI — Conference on Retroviruses and Opportunistic Infections from Sunday to Wednesday, covering breaking developments from investigators on cure research, new antiretroviral agents, hepatitis, tuberculosis and treatment as prevention.

ATLANTA, GA — For years, as the benefits of early treatment for HIV — including preventing illness and transmission — became clear, one of the caveats offered in return was that the earlier patients began to take antiretroviral drugs, the likelier they were to stop, and be lost to follow up care.

Among the reasoning behind that conventional wisdom: if patients took medicine while still healthy the motivation to continue, even while experiencing initial treatment side effects, would be less.

Now a study from the Centre for Infectious Disease Research in Zambia with support from Zambia’s Ministry of Health has countered that thinking, demonstrating that early initiation of antiretroviral treatment among patients whose immune cell counts put them close to the threshold of eligibility for the medicine substantially improved retention of patients.

Brad Guffey of CIDRZ presented the results of the study Tuesday at the 20th Conference on Retroviruses and Opportunistic Infections in Atlanta.

The study, which took place between 2004 and 2011, looked at 6419 adults enrolled into HIV care at 18 sites in Lusaka, Zambia. Of those, 4810 began antiretroviral treatment immediately (defined here as within 180 days), while 1609 did not.

Loss to follow up, which was defined as patients being 60 days or more late for their next clinic or pharmacy visit was greatly higher for those not on treatment (33.9/100 person-years among those who did not immediately start treatment, as opposed to 10.2/100 person-years among those who did).

Researchers say some factors influencing those results remain unknown, including whether some of those patients died, or sought treatment elsewhere.

Still, they concluded, as policy makers weigh the costs and benefits of starting treatment for HIV immediately, they can add better patient retention onto the other individual and public health benefits.

 

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