An article published in the open source journal Plos Medicine, compares two different public health approaches to HIV treatment. The study authors find that the South African approach that used a limited number of drug combinations for all patients was just as effective as the highly individualized approach to drug selection used in Switzerland .
Around 3 million people in sub-Saharan Africa are now receiving antiretroviral treatment using a standardised WHO approach to treatment selection and clinical monitoring. A team of researchers have now investigated whether this approach is as effective as the highly individualised approach to drug selection that occurs in countries such as Switzerland. The difference in treatment regimens for HIV infection between the two countries was quite striking. In South Africa, patients would begin with one of four first-line therapies, and about 25% of them changed to a second-line therapy during the study period. Contrast this with Switzerland, a country that offered 36 first-line regimens and saw about 50% of patients switch to a new regimen during the study. Even with these different approaches to treatment, HIV-1 RNA levels decreased after one year of treatment in patients in both countries. Additionally, both countries saw about 25% of patients develop viral rebound - when viral levels increase after effective initial treatment - within two years.
One notable difference between the two countries, however, was the death rate (especially during the first three months of therapy), which was higher in South Africa than in Switzerland. The researchers suggest that the higher likelihood of South African patients to have advanced AIDS at the beginning of the study could account for this difference. Therefore, there may be gains in initiating therapy as early as possible in South African HIV patients as well as HIV patients in other resource-poor countries.
Read the full article here http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050148
