The first case of HIV is thought to be as long ago as 1930. Today, millions of patients are receiving treatment for HIV/AIDS. Here is an overview of HIV treatment as it stands.
- 1987: The first Antiretroviral Therapy (ART) was introduced, but patients still died from HIV/AIDS.
- 1996: The first highly active ART changed the landscape of the epidemic, from what used to be a death sentence to a chronic, manageable disease.
ART brings down the HIV viral load and makes the virus undetectable. The benefits are twofold. Firstly, viral suppression allows an HIV-infected person to live a healthy, normal life. Secondly, individuals who have an undetectable viral load are no longer able to pass on the disease. Thus, effective treatment protects both the infected and the uninfected.
For this reason, it is vital that linkage to care following diagnosis is improved, access to medication is maintained, retention on treatment is championed, and adherence is strongly supported.
The South African policy guidelines for administration of ART was updated in 2016 to fall in line with WHO guidelines. Under this policy, everyone is advised to initiate onto ART immediately following a positive diagnosis, regardless of their CD4 count. Previously, those infected would have to wait for their CD4 count to fall below a specified threshold before initiating treatment.
Ongoing scientific research seeks new ART regimens (where different combinations of ARV drugs are tested) which optimise efficacy and reduce side effects. The development of specialised drug regimens aimed at particular populations is essential to achieving this.
The longest standing DTHF team, since 1996, has been involved in the conduction of antiretroviral therapy (ART) drug trials and the exploration of novel drug and therapeutic strategies. These include the SMART (Strategies for Management of Antiretroviral Therapy) studies. This unit additionally is involved in HIV prevention studies, described here.
The adherence research at DTHF looks at how patients interact with treatment. Adherence projects that are in progress or proposed include:
- The TAP study which supplied patients with a real-time electronic adherence monitoring device with a text message and dosing feedback. They will determine whether this device improves adherence, retention in care and virological outcomes among patients receiving new ARTs.
- The META study which aims to measure early treatment adherence in different cohorts of HIV-positive patients: high and low CD4 counts. This study will be carried out at two research sites in Uganda and South Africa.
- The ADD-ART study looks at ARV drug levels to assess and manage ART Adherence in South Africa. This study examines people with suppressed viral loads at 4 to 24 months into ART. This prospective study will determine an objective, clinically relevant, and actionable measure of adherence in low-resource settings.
- An ART Refusal Study which will examine the correlates and outcomes of HIV treatment refusal in an adult South African cohort. This study will recruit people who have a positive HIV diagnoses and have chosen not to commence ART.
Both HIV and TB are widespread in South Africa. Often HIV-positive people also get TB because HIV weakens the immune system. As a result, DTHF researches the integration of TB and HIV medications. Research began at the Nyanga Community Health Clinic.
The team has conducted research on how HIV status and use of ARTs affect patients newly infected with tuberculosis. Additionally, there are studies on HIV and TB treatment adherence, as well as anaemia severity and mortality.
DTHF/C History of involvement with HIV Treatment
The Desmond Tutu HIV Foundation (DTHF) is involved in researching new and more effective therapies, drug classes, and antiretroviral drug combinations that can extend and improve the quality of life for people living with HIV/AIDS. Our research began at Somerset Hospital in the early 1990s and focused on early antiretroviral drug trials. These have continued at Groote Schuur Hospital where we have established the University of Cape Town (UCT) Clinical Research Centre. This is a dedicated clinical trials unit in partnership with UCT’s Departments of Medicine and Pharmacology.
The treatment division was instrumental in supporting the roll-out of antiretroviral treatment in Cape Town. The DTHF, in partnership with the Western Cape Department of Health, established one of the first dedicated community ART clinics; the Hannan Crusaid Treatment Centre in Gugulethu. In 2005, the treatment division facilitated ART initiation in Masiphumelele through the Cipra-SA Project 1 ART trial. This study compared ART treatment outcomes amongst patients managed by nurses and by doctors. Both these sites also received PEPFAR support via the DTHF.
Alongside the initiation of life-saving interventions, comprehensive databases were developed in both these patient cohorts. These data, which has been meticulously collected over many years, have contributed to our understanding of the impact of the antiretroviral treatment programs at a community level in South Africa.
The operational research carried out at both Hannan Crusaid and Masiphumelele have helped inform HIV policy and guidelines in South Africa. It has also contributed to national and international collaborations including the IeDEA Network, The Harvard University Center for AIDS Research and the South African Centre for Epidemiological Modelling and Analysis (SACEMA)