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Controversy regarding strategic treatment interruptions in young children who start ART during infancy
Theo Smart, 2012-03-09 09:10:00
Two studies generated conflicting data and rather mixed messages about whether it is safe or advisable to strategically interrupt treatment in children (STIC) who have initiated antiretroviral therapy (ART) during infancy – in order to reduce the challenges of adherence and the risks of long-term toxicity and resistance associated with lifelong therapy – at the 19th Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle.
“Treatment interruption was not feasible for our study population,” said Dr Dalton Wamalwa of the University of Kenya who presented the results of the Optimizing Pediatric HIV-1 Therapy 03 (OPH-3) study.1 In contrast Dr Mark Cotton of Stellenbosch University in South Africa, who presented final results from the pivotal CHER study (see below), reported that, “stopping treatment at the first and second birthday appears safe.”2
But there were some caveats. Dr Cotton noted there was a trend towards better results in those remaining on treatment until at least their second birthday (and that there had been no comparison to longer or continuous treatment in the study). Furthermore, the time that the children could remain safely off-treatment before re-starting was not very great (a median of 33 weeks or 70 weeks depending on the arm), which led Dr Andrew Prendergast of Queen Mary College, University of London, to ask whether such a duration of treatment interruption is long enough to be worthwhile, during a presentation he gave on Wednesday on the controversies of early ART initiation in children.3
While the presenters of both STIC studies stressed that their research was not the final word on the subject – and that further analysis and research is needed – Dr Prendergast’s presentation was followed by some heated discussion on the ethics of treatment interruption in children.
Source:1
