01 July 2013

Antiretrovirals should be given sooner

Doctors could save three million more lives by offering Aids drugs to people with HIV much sooner after they test positive, the World Health Organisation said.


Doctors could save three million more lives worldwide by 2025 if they offer Aids drugs to people with HIV much sooner after they test positive for the virus, the World Health Organisation said on Sunday.

While better access to cheap generic Aids drugs means many more people are now getting treatment, health workers, particularly in poor countries with limited health budgets, currently tend to wait until the infection has progressed.

But in new guidelines aimed at controlling and eventually reducing the global Aids epidemic, the UN health agency said some 26 million HIV-positive people – or around 80% of all those with the virus – should be getting drug treatment.

The guidelines, which set a global standard for when people with human immunodeficiency virus (HIV) should start antiretroviral treatment, were drawn up after numerous studies found that treating HIV patients earlier can keep them healthy for many years and also lowers the amount of virus in the blood, significantly cutting their risk of infecting someone else.

"We are raising the bar to 26 million people," said Gottfried Hirnschall, the WHO's HIV/Aids department director.

"And this is not only about keeping people healthy and alive but also about blocking further transmission of HIV."

Some 34 million people worldwide have the HIV virus that causes Aids and the vast majority of them live in poor and developing countries. Sub-Saharan Africa is by far the worst affected region.

But the epidemic – which has killed 25 million people in the 30 years since HIV was first discovered – is showing some signs of being turned around. The United Nations Aids programme UNAIDS says deaths from the disease fell to 1.7 million in 2011, down from a peak of 2.3 million in 2005 and from 1.8 million in 2010.

Swift progress has also been made in getting more HIV patients into treatment, with 9.7 million people getting life-saving Aids drugs in 2012, up from just 300 000 people a decade earlier, according to latest WHO data also published on Sunday.

Beating the disease

Indian generics companies are leading suppliers of HIV drugs to Africa and to many other poor countries. Major Western HIV drug manufacturers include Gilead Sciences, Johnson & Johnson and ViiV Healthcare, which is majority-owned by GlaxoSmithKline.

Margaret Chan, the WHO's director general, said the dramatic improvement in access to HIV treatment raised the prospect of the world one day being able to beat the disease.

"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," she said in a statement.

The WHO's guidelines encourage health authorities worldwide to start treatment in adults with HIV as soon as a key test known as a CD4 cell count falls to a measure of 500 cells per cubic millimetre or less.

The previous WHO standard was to offer treatment at a CD4 count of 350 or less, in other words when the virus has already started to damage the patient's immune system.

The guidelines also say all pregnant or breastfeeding women and all children under five with HIV should start treatment immediately, whatever their CD4 count, and that all HIV patients should be regularly monitored to assess their "viral load".

This allows health workers to check whether the medicines are reducing the amount of virus in the blood. It also encourages patients to keep taking their medicine because they can see it having positive results.

Sticking to the treatment

"There's no greater motivating factor for people to stick to their HIV treatment than knowing the virus is 'undetectable' in their blood," said Gilles van Cutsem, the medical coordinator in South Africa for the international medical humanitarian organisation Médecins Sans Frontières (MSF).

MSF welcomed the new guidelines but cautioned that the money and the political will to implement them was also needed.

"Now is not the time to be daunted, but to push forward," MSF president Unni Karunakara said in a statement. "So it's critical to mobilise international support... including funding for HIV treatment programmes from donor governments."

The WHO's Hirnschall said getting Aids drugs to the extra patients brought in by the new guidelines would require another 10 percent on top of the $22 to $24 billion a year currently needed to fund the global fight against HIV and Aids.


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Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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