Starting ART early prevents tuberculosis

That starting antiretroviral therapy (ART) in discordant couples, where one of the two partners is HIV positive, results in 96 per cent reduction in sexual HIV transmission became clear after the HPTN 052 trial. The trial took place between 2005 and 2010 in 12 countries, and had an intervention group and a control group.

The intervention group received ART, counselling, free condoms, testing and treatment for sexually transmitted infections. Except for ART, the control group got every other every medical and non-medical attention.

The YRG Care Medical Centre based in Chennai was one of the trial sites. They had recruited 250 volunteers. After completion of the trial, Dr. N. Kumarasamy, Principal Investigator of the trial and also the Chief Medical Officer at YRG Care undertook a sub-analysis whose primary objective was to investigate whether those in the intervention group showed any reduction in active TB incidence.

“We saw very significant reduction in TB incidence in those who got ART,” said Dr. Kumarasamy. “The trial has shown positive effects in TB prevention in those who are infected with HIV. So the ART programme should start medication on patients even before the CD4 count drops to less than 350.”

There may be the additional benefit of preventing active TB in HIV infected individuals, but will early initiation of ART not prove to be more expensive? “No, we found it to be cost effective, both to the participants and the programme offering ART,” he responded.

According to him, YRG Care in collaboration with Harvard University did the costing using an HIV microsimulation model. Data from India and South Africa were used to arrive at costing. “We found it to be cost effective if we start treatment early,” he said.

For the HIV positive individual, in the absence of early treatment the CD4 count tends to drop, thus putting him at risk of developing TB disease. “So there is a cost towards medicines and lost wages for the HIV infected person,” he said. For the programme, starting treatment early will prove to be expensive. “But there is cost when a patient becomes infected with active TB and is admitted. So early initiation of ART reduces cost in the long run,” he explained.

According to him, early initiation of ART has three benefits — it helps reduce HIV transmission, prevents TB and reduces cost in the long run.

Published in The Hindu on September 12, 2012