As Haiti continues to grapple with the aftermath of the Port-au-Prince earthquake, much of the news media has focused on other stories as the acuity of the crisis has passed. However, before the earthquake, Haiti had attracted a large amount of attention from health care professionals who hoped to make a difference in the lives of poor Haitians with medical conditions. The relatively high prevalence rate of HIV in Haiti also presents an opportunity to study how HIV/AIDS treatment could be brought to a resource poor nation.
Although the population of Haiti is only 10 million, the lessons learned there could inform public health researchers about the possible pitfalls of treating HIV positive patients in a resource poor setting.
Recently, a study published in the New England Journal of medicine looked at looked at the clinical effects of giving HIV positive patients, who have the CD4 count above 200 and below 350, antiretroviral medication. Normally, HIV positive patients in Haiti would only receive antiretroviral medication have they develop the symptoms of AIDS or had a CD4 count less than 200. However, the HIV patients with a CD4 count between 200 and 350 have active viral replication which suppresses their CD4 count below the normal range of 500 to 1500.
The study was completed between 2005 and 2008, and thus was not affected by the recent earthquake. Previous studies had hinted that earlier initiation of antiretroviral therapy in HIV/AIDS patients would allow them to live longer. This is because it is now believed that HIV may begin damaging the human body from the first week of infection, and that the earlier treatment is initiated then the earlier the virus can be suppressed to low levels.
The results of this study showed that the early initiation of antiretroviral treatment in HIVAIDS patients with a CD four count between 200 and 350 in Haiti reduced deaths by 75% and reduce the incidence of tuberculosis by 50%. This finding is important as it shows that earlier initiation of treatment for HIV patients decreases mortality as well as prevents cases of tuberculosis. Worldwide, it is believed that increasing prevalence of HIV infection is a factor which pushes up the number of tuberculosis cases reported each year. This is because immune suppressed patients, such as those who are HIV positive, are more likely to become infected with tuberculosis.
In addition, the findings may indicate that the initiation of early treatment in resource for setting such as Haiti, where malnutrition and chronic infectious diseases are common, maybe even more effective than in more developed countries.
What will this mean for the treatment of HIV/AIDS patients?
Some infectious disease specialists in the United States are now recommending that their patients began antiretroviral treatment as soon as they learn that they are HIV positive. Although this is not universally recommended, this present study in Haiti will encourage earlier treatment for HIV positive patients, especially in developing countries.
However, a big question will be whether or not the Obama administration, and other donor parties, will step up to provide the funds they would be required to treat more HIV positive patients. Whether or not this happens, the best standard of care for HIV positive patients in resource settings with CD4 counts between 200 and 350 appears to be the initiation of antiretroviral therapy.
