Earlier HIV Treatment Recommended By WHO
In fact, life expectancy for HIV-positive patients with well-controlled modern treatment is the same as for the rest of the population
The authors of the new guidelines - "Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection" - added that earlier treatment could save an extra three million lives and prevent 3.5 million more people from becoming infected with HIV by 2025.
At the end of 2012, approximately 9.7 million people were taking these lifesaving ART medications, WHO informed.
Dr Margaret Chan, WHO Director-General, said "These guidelines represent another leap ahead in a trend of ever-higher goals and ever-greater achievements. With nearly 10 million people now on antiretroviral therapy, we see that such prospects - unthinkable just a few years ago - can now fuel the momentum needed to push the HIV epidemic into irreversible decline."
Treatment should start at ≤500 CD4 cells/mm3When an HIV-positive adult's CD4 cell count is 500 cells/mm3 or lower they should start treatment immediately. At this point their immune systems are still strong. This is a much higher CD4 cell count threshold compared to the previous 2010 recommendation of 350 CD4 cells/mm3 or less. Brazil, Argentina and Algeria are already offering treatment when patients' CD4 counts drop to the higher level.
According to WHO, there is clear evidence that treating HIV-positive people sooner with easier to manage, safe and affordable medication can:
- keep patients healthy
- reduce the blood-virus load
- lower the risk of HIV human-to-human transmission
Researchers from the Institut Pasteur, Paris, France, wrote in PLoS Pathogens (March 2013 issue) that 14 HIV-infected patients were "functionally cured". Asier Sáez‐Cirión and team say that the key is to start treatment as soon as possible after HIV infection.
Recommendations for HIV-positive children and other patientsThe new WHO guidelines also urge nations to provide ART therapy to all HIV-positive children aged 5 years or less no matter what their CD4 counts are, as well as all HIV-positive pregnant and breastfeeding women. These women's uninfected partners should also be provided with antiretroviral therapy.
Adults initiating ART should be immediately given the same daily single fixed-dose combination pill. It is safer than taking separate pills. Treatment adherence rates are much higher among those on the single daily combination pill. This therapy is suitable for older children, adolescents, pregnant mothers and all other adults.
The single fixed-dose combination pill contains the active ingredients of three antiretroviral medications:
- lamivudine (emtricitabine is the combination of tenofovir plus lamivudine)
"Advances like these allow children and pregnant women to access treatment earlier and more safely, and move us closer to our goal of an AIDS-free generation. Now, we must accelerate our efforts, investing in innovations that allow us to test new born babies faster and giving them the appropriate treatment so that they enjoy the best possible start in life."
HIV therapies should be linked to other treatmentsCountries should link health services more closely. HIV services should be provided alongside those for tuberculosis, maternal and child health, sexual health, reproductive health, and drug dependence.
Dr Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said "The new WHO guidelines are very timely in view of the rapid progress we have made in expanding programs for prevention and treatment. This is an example of how the Global Fund and the WHO work together to support countries as we move towards removing HIV as a threat to public health."
The Global Fund was created in 2002. It has supported over 1,000 programs in 151 nations, and provided HIV treatments for approximately 4.2 million people.
HIV treatment areas still in need of attentionUNICEF, UNAIDS and WHO say some areas of HIV treatment worldwide are still in urgent need of attention:
- 10% more eligible children were on ART in 2012 compared to 2011, but this is still too low. The increase among adults was 20%
- Sex workers, transgender people, men who have sex with men, and those who inject drugs still face cultural and legal obstacles which prevent them from receiving otherwise easily-available treatments for HIV infection. Daily tablets of tenofovir alone were found to reduce HIV infection risk among people who inject drugs by 50%.
- Too many people "drop out" of treatment
New recommendations are feasibleWHO says that despite some of the challenges listed above, its new update contains promising data which clearly show that the new recommendations for earlier ART are achievable.
The number of eligible people on ART could be expanded to 26 million.
An extra 1.6 million people went on antiretroviral therapy between 2011 and 2011 - a record increase. By the end of 2012 there were 9.7 million patients on ART.
Wider HIV treatment was observed in every part of the world, especially in Africa. Out of every five people who started treatment in 2012, four of them were living in sub-Saharan Africa.
Executive Director of the Joint United Nations Program on HIV/AIDS (UNAIDS), Michel Sidibé, said:
"Today nearly 10 million people have access to lifesaving treatment. This is a true development triumph. But we now have a new challenge - ensuring that all 26 million people eligible for treatment have access - not one person less. Any new HIV infection or AIDS-related death due to lack of access to antiretroviral therapy is unacceptable."
WHO released its recommendations on earlier ART on the opening day of the International AIDS Society 2013 conference in Kuala Lumpur. The conference is held every two years.
Scientists from the Duke Human Vaccine Institute and the NIH Vaccine Research Center said that they are step closer to making an HIV vaccine.
Written by Christian Nordqvist
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