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No adverse social consequences from early ART initiation in West Africa
Michael Carter, 2016-04-05 07:20:00
of antiretroviral therapy (ART) does not have negative social consequences,
investigators report in the online edition of AIDS. Research involving patients in Côte d’Ivoire showed that
there were no differences in key social indicators such as relationship status,
HIV disclosure and HIV-related discrimination between patients who started
treatment early and those who initiated treatment according to guideline
start and adhere to ART may be difficult for people at the early stages of
infection,” comment the authors. “Documenting the absence of detectable
associated negative social effects is thus reassuring with regard to the social
feasibility of very early ART and may help remove barriers to entry in
Results of two
large randomised controlled trials have clearly shown the health benefits of
early ART. Moreover, HIV therapy that achieves viral suppression has important
public health benefits. However, the social consequences of early ART are
undocumented. This is an important gap in the research. Negative experiences
such as partner rejection or experiencing HIV-related discrimination could
deter people from starting HIV treatment when their health is good.
uncertainty, an international team of investigators analysed data collected in
the TEMPRANO-ANRS12136 study, a trial conducted in Côte d’Ivoire involving
patients randomised to take early ART or to wait until guideline thresholds.
Over 24 months of
follow-up, patients completed questionnaires that enquired about key social
aspects of life with HIV:
- Living alone (yes/no)
- Being in a relationship
- Disclosure of HIV inside
(yes/no) or outside (yes/no) the household
- Having a regular job in the
previous six months (yes/no)
- Having experienced HIV-related
discrimination in the previous twelve months (yes/no).
A total of 2061
patients (early ART: 1033; deferred ART: 1028) completed at least one socio-behavioural questionnaire during the study.
Median CD4 count at baseline was 469 cell/mm3 and 91% were
asymptomatic or had very mild symptoms of HIV disease.
Over the 24 months
of the study there were no differences in any of the indicators between the
early and differed treatment groups.
believe this is the first study to address the social repercussions of early
“As a whole, these
results show that early ART in a West African context appears to combine
clinical and preventative benefits that are not impaired by potential adverse
social effects,” conclude the researchers. “This reinforces the relevance of
generalized recommendations of ART initiation as soon as possible for
HIV-infected people in Africa.”