WHO: Treat people with HIV early to help them live longer and to help slow virus' spread
LONDON - Young children and certain other
people with the AIDS virus should be started
on medicines as soon as they are diagnosed,
the World Health Organization says in new
guidelines that also recommend earlier
treatment for adults.
The advice will have the most impact in
Africa, where nearly 70 per cent of people
with HIV live. Many rich countries already
advocate early treatment. WHO's new
guidelines were released Sunday at the
International AIDS Society meeting in Kuala
Lumpur, Malaysia.
About 34 million people worldwide have
HIV, the virus that causes AIDS. HIV attacks
key infection-fighting cells of the immune
system known as T-cells. When that count
drops to 200, people are considered to have
AIDS. In the past, WHO recommended
countries start treating people with HIV
when their T-cell count fell to 350; a normal
count is between 500 and 1,600.
The new recommendations say to treat
earlier, when the T-cell count hits 500.
In addition to children younger than 5, WHO
says several other groups should also get
AIDS drugs as soon as they're diagnosed
with HIV: pregnant and breast-feeding
women, people whose partners are
uninfected and those who also have
tuberculosis or hepatitis B.
The guidelines mean an additional 9 million
people in developing countries will now be
eligible for treatment. At the moment, only
about 60 per cent of people who need the
life-saving drugs are getting them.
"WHO has recognized that time is the most
important commodity when it comes to
battling the HIV epidemic," said Sharonann
Lynch, HIV policy adviser at Doctors Without
Borders, which contributed to the new
guidelines.
She said that while the costs for rolling out
this treatment might be expensive, the
strategy would ultimately result in fewer
HIV infections and deaths in the future.
"It's pay now or pay later," she said.
The guidelines also mean the total global
spending on AIDS — about $23 billion a
year — will rise by about 10 per cent,
according to Gottfried Hirnschall, director of
WHO's HIV department. It's unclear how
willing donors will be to pitch in for even
more AIDS treatments.
Hirnschall said the cheapest course of the
drugs costs $127 per person every year
under programs that have negotiated prices
for poor countries, but the price can be
much higher elsewhere. WHO's
recommended treatment is a single pill that
combines three powerful drugs taken once
daily.
In the U.S., officials recommend that
everyone who has HIV should be on
treatment but say there is only "moderate"
evidence for starting therapy when the
immune system is still working normally.
WHO's new guidelines are based largely on
recent studies suggesting people with HIV
who start treatment before their immune
systems weaken live longer. The case of a
U.S. baby girl with HIV who was treated
aggressively within 30 hours of being born
suggests very early treatment could prevent
the virus from ever getting a foothold.
Earlier this year, doctors announced the
little girl from Mississippi was apparently
cured after stopping medication for about a
year with no signs of infection.
Several studies have also hinted that
starting therapy early dramatically cuts the
chances an infected person will pass the
virus to a sexual partner.
If all countries start treating people with
HIV in line with the new recommendations,
WHO estimates 3 million lives could be
saved and 3.5 million new infections could
be avoided in the next decade.
But convincing people to take a lifelong
regimen of drugs that come with side
effects including liver problems and severe
skin reactions, will be challenging.
"These drugs are not like sweeties," said
Dr. Sarah Fidler, an HIV expert at Imperial
College London who is leading a trial in
Africa studying issues including the
effectiveness of immediate treatment for
people with HIV. She had no role in the
WHO guidelines.
Studies in Africa have shown varying
compliance rates from 50 per cent to more
than 90 per cent, similar to elsewhere in
the world. If patients aren't taking their
medicines at least 70 per cent of the time,
that could also lead to drug resistance.
Fidler said that while the WHO guidelines
are a step in the right direction,
implementing them would not be easy.
"For people struggling with other issues like
poverty, taking pills for a disease that isn't
making them sick yet might not seem like
the most important thing in the world," she
said. "This is not going to be as simple as
just giving drugs to everybody."
