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Start Aids treatment sooner, WHO advises
Drugs should be given a year or two earlier than normal to increase patients' chances of surviving
- Reuters
- Published: 00:00 December 1, 2009
London: People infected with the virus that causes Aids should start treatment earlier than currently recommended, the World Health Organisation said on Monday.
The UN agency issued new guidance advising doctors to start giving patients Aids drugs a year or two earlier than usual. The advice could double the number of people worldwide who qualify for treatment, adding an extra three to five million patients to the five million already awaiting Aids drugs.
WHO's previous HIV treatment advice was published in 2006. Since then, several studies have shown people with HIV who start drugs earlier than recommended have a better chance of surviving.
WHO now advises doctors to start HIV patients on drugs when their level of CD4 cells — a measure of the immune system — is about 350. Previously they said doctors should wait until patients' levels hovered around 200. In most Western countries, doctors start treating HIV patients when their CD4 count is about 500.
Compelling evidence
David Ross, an Aids expert at the London School of Hygiene and Tropical Medicine, said there is compelling evidence HIV patients should start treatment sooner. People with HIV who aren't on Aids drugs are more likely to catch a potentially fatal disease like tuberculosis or develop other complications when they do start the drugs, Ross said.
WHO's new recommendations also advise pregnant women with HIV to take the drugs earlier and while breast-feeding. The agency also said countries should phase out the use of the commonly used Aids drug stavudine because of its toxic side effects.
If countries with large outbreaks adopt the guidance, many more people could live longer, healthier lives, said Hiroki Nakatani, a top WHO official in a statement.
Still, WHO's advice raises questions about how countries and donor agencies will pay for the lifelong Aids treatment. About four million people worldwide are receiving Aids drugs, but another five million are still waiting in line.
With its new recommendations, WHO guessed that another three to five million people now qualify for the drugs.
It may also be difficult to convince HIV patients to start the drugs sooner, when some may not have any Aids symptoms. Putting more patients on the treatment for a longer period of time could also encourage drug resistance.
Drug to be phased out
The WHO on Monday issued revised guidelines for millions of people infected with HIV, the virus that causes Aids.
Here are the UN agency's major recommendations:
Countries should phase out the use of Stavudine, the most widespread antiretroviral, because it has "long-term, irreversible" side effects including wasting and a nerve disorder.
Instead, countries should use two other antiretrovirals — Zidovudine (AZT) or Tenofovir (TDF), which are less toxic and equally effective.
HIV patients, including pregnant women, should now start antiretrovirals earlier, when their CD4 count falls to 350 cells/mm3, regardless of symptoms.
To prevent mother-to-child transmission, HIV-positive pregnant women should start using the drugs from 14 weeks into pregnancy, rather than 28 weeks as previously recommended, and continue until the end of breastfeeding.
Breastfeeding should continue until the infant is a year old, providing both mother and child take the drugs. Without treatment, one third of the children living with HIV die before their first birthday and almost half by the second year, the agency said.
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