1. Acceptability of early HIV treatment among South Africa women N Garrett, E Norman, V Asari, N Naicker, N Majola, K Leask,
Q Abdool Karim and SS Abdool Karim AIDS 2016
Durban
Dr Nigel Garrett
Head of HIV Pathogenesis and Vaccine Research
Centre for the AIDS Programme of Research in South Africa

2. No Conflict of Interest

3. Estimated people eligible for ART in 2011 (millions)
When to start ART
Estimated people eligible for ART in 2011 (millions)
CD4 ≤200
CD4 ≤350
CD4 ≤350 +
TB/HIV, HBV/HIV
CD4 ≤500
Test & Treat 1 2 3 4 5
TB/HIV
HBV/HIV
Recommended before 2010
ART regardless of CD4 count for:
HIV-SD couples
Pregnant women
Children < 5 yrs
July 2015
Since 2010
Recent studies, along with an improved understanding of the chronic inflammation caused by HIV, point to the potential clinical benefits of starting
ART at CD4+ count levels above 350 cells/mm3. Some countries have already adapted their national treatment guidelines accordingly. Changing
the ART threshold from 350 to 500 cells/mm3 (in addition to including the groups mentioned above regardless of CD4+ levels), would further increase the pool of people eligible for ART to 26 million.
WHO. Guideline on when to start ART and on PrEP for HIV. September 2015

4. START Study Initiation of ART in Early Asymptomatic HIV Infection
57% reduction in serious AIDS- or non–AIDS-related events including death
The INSIGHT START Study Group, NEJM, 2015

5. Rapid disease progression in HIV-1 subtype C infected women from KwaZulu-Natal
Predictors of rapid progression: CD4 at 3mths (40% loss), VL set-point, Hep B co-infection
K Mlisana, et al. CID 2014

6. CAPRISA 002 Acute Infection Study
Study Start August 2004
232 women enrolled within 3 months of infection
Regular visits during early, chronic infection and on ART
1074 years follow-up (median 6 years)
8 women remain ART naïve
95% retention

7. Assessment of acceptability of earlier ART initiation
1. Temporal trends of CD4 count and VL at initiation in relation to WHO and SA guidelines
170 women from the CAPRISA 002 study contributed data
CD4 count and VL measured 3-6 monthly between

8. Assessment of acceptability of earlier ART initiation
1. Temporal trends of CD4 count and VL at initiation in relation to WHO and SA guidelines
170 women from the CAPRISA 002 study contributed data
CD4 count and VL measured 3-6 monthly between
2. Virological suppression rates after ART initiation at different CD4 count thresholds
Virological suppression defined as <400 copies/ml

9. Assessment of acceptability of earlier ART initiation
1. Temporal trends of CD4 count and VL at initiation in relation to WHO and SA guidelines
170 women from the CAPRISA 002 study contributed data
CD4 count and VL measured 3-6 monthly between
2. Virological suppression rates after ART initiation at different CD4 count thresholds
Virological suppression defined as <400 copies/ml
3. Administration of a standardized questionnaire
Sub-study of ART-naïve women with CD4 >350
Nurse administered, cross-sectional (Nov 2014 to May 2015)
Level of agreement with statements on benefits and drawbacks of early ART

10. CD4 count and VL trends at ART initiation in CAPRISA 002

11. Virological Suppression stratified by CD4 count at ART Initiation

12. Early Treatment Questionnaire
51 ART-naïve CAPRISA 002 participants were eligible and completed the early treatment questionnaire.
All participants were female with a median age of 32 years (IQR ) and 54.9% were from the rural research site.
The majority were unmarried, but with a regular partner (86.3%) and approximately one half (47.1%) were employed.
Three quarters (72.5%) indicated that they had disclosed their HIV status to their partner.
At the time of questionnaire administration, participants had a mean CD4 count of 590 cells/µl and median viral load of 4.1 log copies/ml.

13. Perceived benefits and drawbacks of earlier ART94 92 90 88 84 84 59 57 57 37 35

14. Willingness to initiate ART at CD4 ≥50090 91 70 63 46 30 27 27 8 18

15. Willingness to initiate ART at CD4 ≥50090 91 70 63 46 30 27 27 8 18
Of the 11 women unwilling to initiate at CD4 ≥500, 6 (54.5%) started ART at mean CD4 = 690 cells/µl within 6 months of questionnaire administration after counselling by the study team.

16. Conclusions
Earlier ART initiation is acceptable to most participants as shown by the increasing CD4 count at ART initiation over time and high levels of virological suppression regardless of CD4 count at treatment start.
Although some concerns remain about side effects, stigma, and disclosure, appropriate counseling by healthcare providers can encourage patients to start early and successful HIV therapy.
As South Africa is going to implement ‘Test and Treat’, it is important to strengthen ART programs, so that all HIV-positive patients and communities can reap the benefits of early ART initiation.

17. Acknowledgements We thank the CAPRISA 002 Study Team
and all the CAPRISA 002 study participants
who continue to make an important
contribution to HIV research.
This slide can be customised. However, all acknowledgement slides need to include the logos and partner institutions at the bottom. The wording and logos of sponsors can be customised for each slide set
CAPRISA is the UNAIDS
Collaborating Centre for
HIV Research and Policy
CAPRISA hosts a DST-NRF Centre of Excellence in HIV Prevention
CAPRISA hosts a MRC
HIV-TB Pathogenesis and
Treatment Research Unit
CAPRISA Partner
Institutions: