Low-cost drugs package saves lives of people starting HIV treatment late

Treating people who start HIV treatment late with a package of low-cost drugs to prevent serious infections saves three lives for every 100 people treated, according to the findings of a trial led by the Medical Research Council (MRC) Clinical Trials Unit at UCL. The results from the REALITY trial, which involved 1805 adults, teenagers and children from Kenya, Malawi, Uganda and Zimbabwe and was funded by the MRC, the Department for International Development (DFID) and Wellcome, are published today in the  New England Journal of Medicine . Current practice in Africa is to start HIV treatment together with one antibiotic, cotrimoxazole, to prevent a range of infections. But when people start treatment - late, HIV has already caused severe damage to the immune system and patients have very low numbers of an important blood cell (called CD4 cells) that fights infections. All of patients in the REALITY trial had under 100 CD4 cells per cubic millimetre of blood when the range in healthy people is between 500 and 1500. The researchers recommend that people in Africa starting HIV treatment with low CD4 counts should be given the enhanced prevention package for the first 12 weeks of HIV treatment. Around one in five people starting HIV medicines in low-income countries have CD4 counts under 100 when they start treatment. People living with HIV with low CD4 counts are at high risk of developing serious illnesses after starting HIV treatment and around one in ten will die within the first few weeks of starting treatment because their immune systems cannot recover fast enough.