The World Health Organization suggests that treating people with HIV earlier could save lives and help them stay healthy for longer, while at the same saving money; the organization also estimates that a record 5.2 million people worldwide were receiving life-saving HIV treatment at the end of 2009, compared with 4 million a year earlier.

At the XVIII International AIDS Conference being held in Vienna from 18 to 23 July, WHO Assistant Director-General for HIV, Tuberculosis, Malaria and Neglected Tropical Diseases, Dr Hiroki Nakatani, told the press that:

“This is the largest increase in people accessing treatment in a single year. It is an extremely encouraging development.”

The rate of increase is remarkable: since 2003, when the “3 by 5” campaign was launched (to have 3 million people in poorer nations on HIV treatment by the end of 2005), the increase in the number of people receiving HIV treatment has increased 12-fold.

WHO’s latest estimates show that 1.2 million people started HIV treatment in 2009, bringing the total number receiving treatment to 5.2 million.

WHO is now recommending treating people with HIV earlier: currently HIV-infected people normally receive treatment when their CD4 cell count falls below 200 cells/mm3, the WHO wants treatment to start at 300 cells/mm3. (CD4 cell count is a measure of immune system strength, a healthy person’s count is between 1,000 and 1,500 cells/mm3).

Estimates from epidemiological models suggest that as many as 20 per cent of HIV-related deaths can be avoided between 2010 and 2015 by treating infected people earlier; and deaths from tuberculosis (TB), the number one killer of people with HIV, could be reduced by as much as 90 per cent, if people with both HIV and TB were to start treatment earlier.

If people infected with HIV can start antiretroviral therapy before their immune system gets weak and they fall ill, they are likely to live longer, healthier lives, said Dr Gottfried Hirnschall, WHO Director of HIV/AIDS.

Earlier treatment also boosts prevention, because people then have lower levels of HIV and are less likely to pass it onto their partners, he added.

The effect of recommending earlier treatment will increase the number of HIV-infected people that should be in treatment from an estimated 10 million to an estimated 15 million.

The cost of HIV treatment for 2010 will be about 9 billion US dollars, according to estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS).

But as Dr Bernhard Schwartlander, Director, Evidence, Strategy and Results, UNAIDS, explained, earlier treatment saves money because people with weaker immune systems who get treated later need more complex and more expensive drugs and care.

“The investments we make today can not only save millions of lives but millions of dollars tomorrow,” said Schwartlander.

WHO has also updated their guideline for antiretroviral therapy for HIV infection in adults and adolescents. The guide is aimed at national treatment advisory boards and organizations providing technical, clinical and financial resources in limited healthcare settings.

The guidelines review the case for starting earlier treatment in settings with limited health systems, citing “GRADE evidence profiles, systematic and targeted reviews, risk-benefit analyses, consultations with PLHIV, technical reports, and assessments of impact, feasibility and cost”.

Four separate working groups, the Internal WHO ART Guideline Working Group, the ART Guideline Drafting Group, the external ART Peer Review Panel and the full ART Guideline Review Committee, were involved in the update.

The consensus was that earlier HIV diagnosis and earlier ART “promote the use of less toxic regimens and more strategic laboratory monitoring”.

The updated guideline also details the best first line, second line and subsequent drugs to use with most populations, the best time to start ART, and when to switch to third-line drugs.

The WHO urges that the guidelines be followed in the context of the receiving nation’s HIV epidemic, the strength and weaknesses of their particular healthcare system, and how much support they have in terms of people, money and other essential resources.

They stress the importance of implementing the new guidelines in such a way as not to undermine what is already happening, so that at risk populations continue to have access, and the biggest possible, sustainable impact is created for the greatest number of people.

“Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach (2010 revision).”
World Health Organization, Geneva (pdf)
ISBN: 9789241599764

Source: WHO (Vienna).

Written by: Catharine Paddock, PhD