In
February this year the idea for this project started in church one Sunday
morning. Ds. Quintus Heine who is the secretary of the Bible Society of
South Africa, spoke about various projects involving the Bible Society
at the morning sermon.
The
patients at KIDCRU range between newborns to 8 year old’s. The Parks
congregation Sunday School children in Kraaifontein under the leadership
of Chris Groenewald and Babs van Wyk, as well as Philma Martins from KIDCRU,
started the WORD-project in the second semester. More than R14000 has
been collected with their collection tins.
The
3rd of October 2012, 300 Children’s Bibles were handed to KIDCRU
to distribute between the patients. On this occasion the CAB (Community
Advisory Board) members explained what their goal is and the Sunday school
children had the opportunity to distribute the Bibles themselves.
Every
pediatric patient will receive a Bible at his/her next visit to KIDCRU
and can choose from English, Afrikaans and Xhosa languages.
Treating infants with HIV early, and then interrupting their treatment,
leads to better results than deferring initial treatment
New
research findings show that treating infants with HIV early, and then
giving them a break from treatment, leads to better results than waiting
until they get sicker to start them on treatment. These findings from
the CHER trial were presented at the Conference on Retroviruses and
Opportunistic Infections in Seattle on 6th March 2012.
Infants
with HIV are at a high risk of dying or their disease getting worse while
they are infants. Early treatment with antiretroviral therapy (ART) helps
to prevent this. However, treating infants with ART has its own problems:
starting children on ART is a lifelong commitment, and costs money. The
drugs can have side effects. Their disease may develop resistance to the
drugs that are currently available, and the earlier they start treatment
the more time there is for resistance to develop.
The
CHER (Children with HIV Early antiretroviral) trial was set up to test
whether starting infants on treatment early, but then stopping their treatment
for a while, could help to reduce these problems. Researchers split 377
HIV-infected children randomly into three groups:
those
who did not start treatment until their disease got worse (standard
treatment), but did not interrupt their treatment once they had started
those
who started treatment straight away and stopped after one year, restarting
when their disease got worse
those
who started treatment straight away and stopped after two years, restarting
when their disease got worse
Researchers
followed up these children for up to six years, to study long term outcome.
The
trial found those infants who started ART straight away for one or two
years, and then stopped, were more likely to live & be in good health
by their 5th birthday than those who did not start treatment until later.
For the latter, the average time to start ART was 20 weeks on study. Children
who had ART straight away for two years and then a break were 40% less
likely to have died or their disease to have got worse by the end of the
study than those who started treatment later. The results also suggest
that the children who had early ART for two years could have a longer
break from treatment before their disease got worse than those who had
early ART for only one year.
Mark Cotton of Stellenbosch University, one of the principal investigators
of the trial said: “These results are very encouraging, as they
reinforce the importance of starting infants with HIV on treatment early.
Early treatment followed by a break may become an accepted strategy in
the future. It is definitely better and more cost-effective than delaying
starting infants on treatment.”
Di
Gibb, professor in epidemiology and investigator for the CHER trial at
MRC CTU said: “The study indicates that if you have limited money
for treating children with HIV, starting them on treatment early for the
first year or two will save more lives than if you had used the money
to treat them continuously but waited until early signs of deterioration
before starting.”
The
results presented at the conference are preliminary, and further details
will be available when the results are published in a peer-reviewed journal
later this year. Before these results lead to changes in practice, we
need information about the effect of these treatment breaks on levels
of the virus in children’s blood, and resistance to ART. These results
should be available from the CHER trial later this year.
Very
early results from the trial have already had an impact across the world,
as back in 2008 they led to a change in the World Health Organisation’s
guidelines. Instead of waiting until an infant’s diseases gets to
a certain level before starting treatment, treating infants immediately
was shown to reduce death. The new long-term results reinforce these early
results by now showing that early treatment for one or two years and then
stopping is better than waiting. They provide encouragement that for some
children treatment can be stopped safely for some time, if the child’s
health and immune system is monitored well.
Avy
Violari of the University of Witwatersrand in South Africa, also a principal
investigator on the trial, said: “The next stage might be to compare
early treatment followed by a break with early continuous treatment, to
see which strategy is better for children. We also need to find out what
the optimum length of initial treatment is. In this trial we looked at
one year and two years, and two years seemed better. But it may be that
treating children for 3-5 years could lead to an even longer break before
they need to go back on treatment for life.”
The
trial was carried out in South Africa by the Perinatal HIV Research Unit
of the University of Witwatersrand, the Children’s Infectious Disease
Clinical Research Unit of Stellenbosch University, and MRC Clinical Trials
Unit, as part of the CIPRA-SA programme. The CHER is the first and longest
randomized trial assessing practical strategies (that can be implemented
in low and middle income countries) for the management of infants with
HIV and that its encouraging results highlight the importance of
rolling out testing for HIV in infancy.
The
research was funded by the Division of AIDS, NIAID, NIH and GlaxoSmithKline.
NIAID conducts and supports research—at NIH, throughout the United
States, and worldwide—to study the causes of infectious and immune-mediated
diseases, and to develop better means of preventing, diagnosing and treating
these illnesses. News releases, fact sheets and other NIAID-related materials
are available on the NIAID Web site at http://www.niaid.nih.gov.
