THE Treatment Action Campaign (TAC) is updating its position on HIV treatment in South Africa following the findings from the landmark Strategic Timing of Antiretroviral Treatment (START) trial, which was presented at the International Aids Society Confer

ALL HIV-positive people in South Africa should be recommended for antiretroviral therapy (ART).

START is a randomised controlled trial that examined early versus delayed treatment for people with HIV. It has provided clear evidence that early treatment benefits the health of HIV-positive people. HIV-positive participants who started ART early experienced significantly fewer serious Aids events than people who delayed starting ART until their CD4 counts dropped to 350 cells/mm3 or had an Aidsdefining illness.

The early treatment arm had 14 cases of cancer compared to 39 in the delayed treatment arm. In addition, the early treatment arm had six cases of tuberculosis as opposed to 20 in the delayed arm. The overall Aids-related events rate in the early arm was 1.8 percent compared to 4.1 percent in the delayed arm – which amounts to a relative risk reduction of 57 percent. There were a total of 12 deaths in the early arm compared to 21 in the delayed arm – although this last finding was not statistically significant.

START provides compelling evidence that serious Aidsrelated events like cancer and TB can be prevented by early treatment. In the light of this, all HIV-positive people in South Africa should be recommended ART irrespective of CD4 count. Current treatment guidelines in South Africa recommend ART only once a person’s CD4 count drops to 500 cells/mm3.

Previous research has shown that people on ART with suppressed viral loads are unlikely to transmit HIV. That early treatment benefits the individual patients is thus also good news for HIV prevention.

All people starting ART should receive thorough and accurate counselling about the benefits of taking ART.

Effective pre- and post-test counselling remains an essential part of the HIV treatment programme. Any expansion in treatment provision must be accompanied by a corresponding expansion of human resource capacity to ensure that effective counselling and treatment support services can be provided. Just like people have a right to access treatment, people also have a right to be accurately informed about all the risks and benefits of starting ART.

It is also worth noting that many people who will start