Make HIV medication available early in New Zealand
Prioritising access to meds regardless of CD4 count is in the interest of all
Following the release of findings from an international trial on early benefits of treatment, New Zealand AIDS
Foundation is calling PHARMAC to fund the immediate access to medication for people living with HIV.
“The START trial has found a 53% reduction in serious illness or death for people who begin using medications early,”
says Shaun Robinson, Executive Director, NZ AIDS Foundation. “What is more, HIV medication reduces the level of HIV
virus in a person’s blood which significantly lowers their ability to infect others. With around 100 new HIV infections
occurring in New Zealand each year it is in everyone’s interest to make access to medications as easy as possible.”
In 2014 PHARMAC agreed in principle to remove the CD4 threshold (the clinical definition of when a person with HIV could
access treatments) but made the funding of this decision a medium priority. The new evidence of significant improvements
for people’s health and the secondary benefit of reduced ability to pass on HIV will both provide overall cost benefits
for the health system. “One new HIV infection prevented saves $1 million over a person’s lifetime. It makes economic
sense to fund immediate access to mediations as well as being the right thing for people’s health,” said Mr Robinson.
The new evidence adds weight to the need for people to test for HIV. The START evidence shows that a person’s health
will be dramatically improved if they have their HIV diagnosed and start treatment as soon as possible. “If you have had
unprotected sex, especially if you are a gay or bisexual man, then it is strongly in your interest to test for HIV,”
said Mr. Robinson.
HIV remains incurable. “The decision to start medications should continue to be one made between the individual and
their doctor,” said Mr Robinson. “There are side effects and people need to be ready to commit to a life-long process of
taking the medications every day. However, the START results should be encouraging people to begin treatment
immediately”. The evidence is now clear that there is no clinical or financial reason to have a clinical threshold set
by PHARMAC that stops patients and doctors making the decision to start medications early.
What is the START trial?
The START study was conducted by the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) at 215 sites in 35
countries. The trial enrolled 4,685 men and women living with HIV in ages 18 and older. Participants had never taken
antiretroviral therapy and were enrolled with CD4+ cell counts in the normal range — above 500 cells per cubic
millimetre. Approximately half of the study participants were randomized to initiate antiretroviral treatment
immediately (early treatment), and the other half were randomized to defer treatment until their CD4+ cell count
declined to 350 cells/mm3. On average, participants in the study were followed for three years.
Based on data from March 2015, the independent Data and Safety Monitoring Board (DSMB) found 41 instances of AIDS,
serious non-AIDS events or death among those enrolled in the study’s early treatment group compared to 86 events in the
deferred treatment group. The DSMB’s interim analysis found risk of developing serious illness or death was reduced by 53 percent among those in the early treatment group,
compared to those in the deferred group.
ENDS