Children with HIV early antiretroviral therapy

When and for how long should babies infected with HIV be given antiretroviral therapy?

What was this study about?

One third of HIV-infected babies die before their first birthday; half are dead before they reach two years of age. So it’s really important we learn how best to treat babies with HIV, so that we can reduce the number of early deaths. The CHER trial aimed to see if giving a limited course of ART to babies as soon as possible after their HIV status was known would have a long-term heath benefit, when compared to HIV-infected babies who are treated after they develop symptoms of HIV, or weakened immune systems. Babies were randomised into three groups:

  • In the first group, doctors delayed giving ART to babies until their immune system became weak (measured through a CD4 count)
  • In the second group, doctors gave ART immediately, and stopped this when the babies reached the age of one year
  • In the third group, doctors gave babies ART immediately, and stopped this when they were two years old

What difference did this study make?

The early results from the trial have already had an impact across the world, as back in 2008 they led to a change in the World Health Organisation’s guidelines. Instead of waiting until an infant’s diseases gets to a certain level before starting treatment, the guidelines now recommend treating infants immediately, as the CHER trial showed this saves lives. This trial has also shown how important it is to diagnose HIV as early as possible after a baby is born, and that support for mothers to help them give the ART to their babies is vital. The new long-term results reinforce these early results by now showing that early treatment for one or two years and then stopping is better than waiting. They provide encouragement that for some children treatment can be stopped safely for some time, if the child’s health and immune system is monitored well. In the CHER trial children had initial early treatment for one or two years. It is possible that longer time on initial treatment might be even better. This would need to be examined in future research.

Type of study

Randomised trial

Contact details

Who funded the study?

The US National Institute of Allergy and Infectious Diseases (NIAID); GlaxoSmithKline provided some of the drugs.

When did it take place?

Early results of this trial were published in July 2007 (see below). Researchers continued to follow up the babies who took part in the trial until September 2011. These long-term findings were presented at the CROI conference in 2012.

Where did it take place?

The study was carried out in South Africa.

Who was included?

This study recruited 411 babies with HIV aged between 6 and 12 weeks old.