[Ip-health] MSF response to START trial data showing all people with HIV should be treated immediately

Michelle French Michelle.French at newyork.msf.org
Mon Jul 20 12:02:14 PDT 2015



Vancouver, 20 July 2015―The international medical humanitarian 
organisation Médecins Sans Frontières/ Doctors Without Borders (MSF) 
applauded the results of the Strategic Timing of Antiretroviral Treatment 
(START) trial, released today at the International AIDS Society Conference 
(IAS) in Vancouver, showing that immediate treatment is beneficial for the 
individual regardless of the status of their immune system. This builds 
upon previous evidence that showed HIV treatment itself dramatically 
prevents transmission of the virus. MSF also welcomed the World Health 
Organization’s (WHO) plans to release revised treatment guidelines later 
this year, which are expected to include a recommendation that all people 
be offered antiretroviral treatment immediately after testing positive for 
“Given the new evidence, it should no longer be a question of when to 
start people on treatment, but how to help people stay on treatment for 
life and to maintain ‘undetectable’ levels of virus in their blood,” said 
Sharonann Lynch, HIV/TB Policy Advisor for MSF’s Access Campaign. “The new 
global goal should be to offer treatment to every person living with HIV, 
and to mobilize the political will to match this ambition. We need to see 
a doubling of the pace of scale-up, with more people put on treatment 
every day than the day before.” 
MSF data being released at the IAS Conference in Vancouver―a multi-centric 
study looking at 41 MSF HIV treatment programmes over 10 years―has shown 
that one third of people who were diagnosed with HIV but not eligible to 
start treatment never returned to the facility and were therefore 
considered ‘lost to follow-up.’ Offering such individuals treatment upon 
being diagnosed could help substantially reduce the number of people who 
never return for their follow-up visits in order to eventually start 
“We should no longer squander an opportunity to offer treatment to a 
person living with HIV who is not yet seriously ill, because our 
experience shows that a third of these people will never come back to get 
treatment. We see in our projects that people whose immune systems are 
still strong are nevertheless very willing to start treatment,” said Dr. 
Helen Bygrave, HIV Medical Advisor, MSF Southern Africa Medical Unit. 
“While we focus on the effort to get all people with HIV on treatment, we 
must also muster all resources to make sure the sickest and the most 
vulnerable in low-coverage countries, including children, are urgently 
enrolled into care.”
Further MSF data being released at the conference shows that there is 
strong acceptability among people with high CD4 cell counts to start 
life-long treatment.  In Swaziland, where MSF and the government of 
Swaziland started a ‘test and treat’ pilot, MSF found the acceptability 
and initiation rate of people newly diagnosed with higher CD4 counts was 
as high as those with low CD4 counts (≥87%). 
An MSF population survey from Chiradzulu, Malawi showed that 91% of people 
on ART had an ‘undetectable’ viral load, but for people who tested 
positive for HIV and were not on ART―including those not considered 
eligible for treatment―48% had what is considered a high viral load 
(>100,000 copies/mL), which means HIV is more likely to transmit. Offering 
treatment would not only benefit their own health, but also help prevent 
further transmission.
“In large part, people retained on ART in our projects are achieving 
undetectable levels of virus, but we are failing those who aren’t eligible 
for treatment by leaving them to fend for themselves against a virus that 
weakens their immune system and leaves the virus at high risk of 
transmitting,” said Bygrave. “By strengthening adherence support, through 
counselling interventions and viral load monitoring, we can offer all 
people living with HIV―including those newly diagnosed―the best chance at 
reaching and maintaining an undetectable level of virus.”
Ensuring there is a strong and increasing stream of international support 
for HIV treatment becomes all the more critical at this point, but there 
are troubling signs that the main international funding body for HIV 
treatment, the Global Fund to Fight AIDS, TB and Malaria, may reduce 
future support for some essential interventions, such as recurrent costs 
of commodities, and support to some ‘middle-income’ countries. 
“Now’s not the time to slow down the global HIV response in any way, but 
instead to hit the accelerator to save lives and stop this virus,” said 
Lynch. “Any attempt to withdraw HIV support from countries at this point 
is beyond cynical.” 
MSF is calling for a meeting of donors, governments and scientists during 
the UN Summit for the Adoption of the Post-2015 Development Agenda planned 
for September of this year, in order to review evidence that supports 
escalating the pace of ART scale-up to reach 90% of people living with 
HIV.  This evidence should raise ambitions for the global HIV response to 
a level that will fully leverage the opportunities afforded by the latest 
scientific data.
MSF started providing HIV treatment to people in developing countries in 
2000, and today supports more than 200,000 people living with HIV through 
MSF programmes. 

Michelle French
Sr. Communications Manager, MSF Access Campaign
Doctors Without Borders\Médecins Sans Frontières (MSF)
Office: +1.212.763.5735 | Mobile: +1.646.552.4600
michelle.french at newyork.msf.org | Skype: michellejfrench
www.msfaccess.org | twitter.com/MSF_access | www.facebook.com/MSFaccess

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