No adverse social consequences from early ART initiation in West Africa

Early initiation 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 thresholds.

“Motivation to 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 treatment.”

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.

Given this 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 (yes/no)
• 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 defered treatment groups.

The investigators believe this is the first study to address the social repercussions of early ART.

“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.”