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High Demand For Antiretroviral Drugs In Rural Uganda

July 23, 2012

UCSF-led SEARCH study suggests people with HIV/AIDS would take HIV medicines at early stages of HIV, before they were sick

An ongoing clinical study in rural Uganda, begun in 2011, suggests that many people infected with HIV/AIDS would take antiretroviral drugs if they were available to them–even before they developed symptoms from the disease.

Led by doctors at the University of California, San Francisco (UCSF), the San Francisco General Hospital and Trauma Center (SFGH) and Makerere University School of Medicine in Kampala, Uganda, the study is the first to address such attitudes among African patients who are in the early stages of the disease and not yet sick.

Historically, treatment was initiated only when someone’s immune system had declined below a certain threshold, by which point they were sometimes already ill.

Now, mounting evidence suggests that providing antiretroviral therapy to people long before they get sick can be a direct benefit to both them and society–by keeping the individual healthy, and by reducing the transmission of HIV within communities.

Even so, scientists have known little about patients’ attitudes towards taking antiretroviral therapy in the early stages of HIV disease. “Given that there are millions of people in Africa taking antiretroviral drugs and millions more in need of them, there is surprisingly little data on patients’ attitudes in this part of the world toward the therapy itself,” said Moses Kamya, a professor and chair of the Department of Medicine at Makerere University.

The new clinical study addressed these questions directly. Its first results will be revealed at the XIX International AIDS Conference in Washington, D.C. on Sunday, July 22, 2012.

“There was very high interest among the people eligible for this study in taking antiretrovirals,” said Vivek Jain, MD, MAS, assistant professor of medicine in the UCSF Division of HIV/AIDS at SFGH.

In the study, 188 patients with HIV were enrolled and offered antiretroviral drugs. All had a high CD4+ T cell count (>350)–the classic measure of the immune system’s robustness and an indication of being in the early stages of disease, before a decline towards AIDS.

Almost all of the patients–186 of 188–elected to take the treatment. Ninety percent identified the main reason why they wanted to start therapy as their desire to stay healthy, 52 percent cited a desire to continue working and an equal 52 percent cited a desire to continue caring for their families. Other leading reasons patients wanted to take therapy centered around their desire not to transmit HIV to partners and future children.

The poster, “Patient attitudes toward HIV antiretroviral therapy initiation at high CD4+ cell counts” by Vivek Jain, Dathan Byonanebye, Jemimah Muhaawe, Jane Kabami, Doug Black, Tamara Clark, Gabriel Chamie, Elvin Geng, James Rooney, Edwin Charlebois, Gideon Amanyire, Diane Havlir, Moses Kamya, and the SEARCH Collaboration will be unveiled at 3:00 p.m. ET on Sunday, July 22, 2012.

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