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Study backs HIV treatment in poor countries

25/04/2008

A lack of hi-tech laboratories in poor countries should not prevent antiretroviral treatment (ART) being given to people with HIV, researchers say.

When people in poor countries began receiving advanced drug therapies there were concerns patient care would suffer because few high tech laboratories were available to guide treatments.

But a study published today in the Lancet says monitoring of clinical events, such as weight loss and fever, is almost as effective as using advanced laboratory analysis.

The study's authors say their findings show lack of laboratory access should not be allowed to hinder access to and roll-out of ART.

They used a validated computer simulation model of HIV infection and the effect of ART to compare survival; use of World Health Organisation-recommended standards first and second line ART; and development of resistance that result from the three different strategies.

These strategies were viral load monitoring, CD4 (a critical immune component) monitoring and clinical monitoring.

The five-year survival rate for each strategy was 83 per cent, 82 per cent and 82 per cent respectively.

"Our results suggest that use of ARV therapy without monitoring of viral load or CD4 cell count does not have marked detrimental effects on patient survival or on development of resistance," the researchers conclude.

"This finding is particularly relevant in view of the limited array of anti-retroviral combinations available to the developing world.

"Access to ARV therapy should be expanded to all settings as rapidly as possible; lack of access to laboratory monitoring should not be allowed to hinder this process."

Study co-author Dr Charles Gilks, the co-ordinator of ART and HIV care at the World Health Organisation in Geneva, commented: "The results of this study should reassure clinicians in Africa and Asia, who are treating literally millions of people without these laboratory tests, that they are not compromising patient safety.

"In fact, the outcome of their treatment is almost as good as those patients in the USA and Europe where laboratory-guided treatment is the norm."