Recently published research results in the NEJM suggest that early initiation of anti-retroviral therapy in newborns can have a profound effect on early mortality, even in low-income settings. In the trial, HIV infected babies were randomized to begin treatment immediately or to wait until they qualified using existing clinical guidelines. I thought this study had a few really interesting findings.

First, mortality declines for the early treated patients was substantial – a nearly 80% reduction.

Second, nearly two thirds of those who were randomized to the wait until needed approach ended up needing treatment anyway. Just missing that early treatment opportunity really makes a big difference for newborns.

I attended a conference last week on ARV treatment in Africa at HMS and I gathered from the clinical experts is that there is a big move underway to move treatment initiation up for adults as well. What will all of these changes have on the way in which national ARV treatment programs are being run?

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