{"id":931,"date":"2010-05-14T21:42:56","date_gmt":"2010-05-15T01:42:56","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=931"},"modified":"2015-06-04T15:25:14","modified_gmt":"2015-06-04T19:25:14","slug":"the-luxury-of-the-start-study-and-running-out-of-art-in-uganda","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/the-luxury-of-the-start-study-and-running-out-of-art-in-uganda\/2010\/05\/14\/","title":{"rendered":"The Luxury of the START Study &#8230; and Running Out of ART in Uganda"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-932\" title=\"Sub-Saharan_Africa\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2010\/05\/Sub-Saharan_Africa1.gif\" alt=\"Sub-Saharan_Africa\" width=\"269\" height=\"251\" \/>Over on our <em>Journal Watch AIDS Clinical Care<\/em> site, we did a <a href=\"http:\/\/features.jwatch.org\/pfwPollArchive.aspx\" target=\"_blank\">poll<\/a> asking about the ongoing START study:<\/p>\n<blockquote><p>In the START study, HIV-infected patients with CD4 counts greater than  500 cells per cubic mm are being randomized to start antiretroviral  therapy right away or to wait until the CD4 count falls to 350 cells per  cubic mm or below. If there were a START study site in your community,  would you refer eligible patients to it?<\/p><\/blockquote>\n<p>87% said they would &#8212; which is interesting, since the study is having trouble enrolling, at least in some sites.\u00a0 If the study succeeds, we may learn definitively if treatment should be started at CD4 cell counts &gt; 500, a longstanding debate in the field.<\/p>\n<p>But the dilemma posed by the START study stands in sharp contrast to <a href=\"http:\/\/www.nytimes.com\/2010\/05\/14\/opinion\/14fri2.html?pagewanted=print\" target=\"_blank\">this life and death news<\/a> about HIV treatment programs running out of money in Sub-Saharan Africa:<\/p>\n<blockquote><p>The global war on AIDS has racked up enormous successes over the past  decade, most notably by providing drugs for millions of infected people  in developing countries who would be doomed without this life-prolonging  treatment. Now the campaign is faltering &#8230;<\/p>\n<p>Although the number of Ugandans receiving drug treatments jumped from  fewer than 10,000 a decade ago to nearly 200,000 today, hundreds of  thousands more Ugandans need the drugs and likely can\u2019t get them because  clinics now routinely turn new patients away.<\/p><\/blockquote>\n<p>In the context of a limited supply of medications, the best approach to providing HIV treatment is to treat the sickest first &#8212; patients such as those described <a href=\"http:\/\/www.nytimes.com\/2010\/05\/10\/world\/africa\/10aids.html\" target=\"_blank\">here<\/a> in this NY Times article.\u00a0 But after the drugs run out, then what?<\/p>\n<p>All of which goes to show that even the <em>option<\/em> of doing the START study is an incredible luxury, and that a person needing treatment for HIV is very very lucky to live here and not in Sub-Saharan Africa.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Over on our Journal Watch AIDS Clinical Care site, we did a poll asking about the ongoing START study: In the START study, HIV-infected patients with CD4 counts greater than 500 cells per cubic mm are being randomized to start antiretroviral therapy right away or to wait until the CD4 count falls to 350 cells [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[77,423,872],"class_list":["post-931","post","type-post","status-publish","format-standard","hentry","category-health-care","tag-antiretroviral-therapy","tag-hiv","tag-start-study"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/931","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=931"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/931\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=931"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=931"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=931"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}