WHO Recommends Earlier Treatment of HIV

Antiretroviral therapy for HIV is now recommended earlier in treatment

(RxWiki News) The AIDS epidemic is becoming more and more contained as doctors, researchers and organizations band together to study and fight this seemingly unstoppable virus. Fortunately, things are starting to look up.

A recently released report on HIV treatment stated that early antiretroviral therapy (ART) may be a huge step towards the containment of this epidemic. 

AIDS organizations and health professionals are now using ART to treat more people than ever around the world. Research has shown that early treatment can be a much safer and healthier option for most HIV-positive individuals, even those as young as infants.

The authors of this report concluded that the global effort to improve the availability of both education and ART are substantially lowering both HIV deaths and disease transmissions worldwide.

"Talk to your doctor about antiretroviral therapy."

The World Health Organization (WHO) released these new HIV treatment recommendations last month at the International AIDS Society conference in Kuala Lumpur.

These new guidelines focus on treating patients sooner after their initial diagnosis with antiretroviral therapy (ART), and were released as part of the WHO's "Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection." 

ART has recently been found to help HIV patients live longer and healthier lives. This treatment has also played a huge part in considerably reducing the risk of HIV transmission.

The new guidelines contain recent data on the success of ART, showing that there were 9.7 million people around the world in 2012 who were using what the WHO calls a "lifesaving drug." The new plan to begin ART earlier has the potential to prevent an additional three million deaths and 3.5 million new HIV infections between now and 2025.

Dr. Margaret Chan, WHO Director, explained, "These guidelines represent another leap ahead in a trend of ever-higher goals and ever-greater achievements [in HIV treatment]." She maintains that these new ART recommendations will continue to push HIV treatment and research to new and better levels, eventually forcing the HIV epidemic into "irreversible decline."

In 2010, the WHO recommended that ART be used when a patient's cell count fell to 350 CD4 cells/mm³ or less. The new recommendation states that treatment should be administered when the patient's CD4 cell count falls to 500 CD4 cells/mm³ or less because the patient's immune system is still strong at that level. 

A CD4 cell is the type of white blood cell with receptors called CD4 on the surface. The HIV virus attaches to the CD4 receptor on white blood cells in order to affect the immune system. Doctors keep track of HIV patients' CD4 counts in order to monitor whether or not treatment is needed or is working.

This new recommendation is based on data showing that early, safe, affordable and easy-to-manage treatment of people with HIV will allow for a healthier life with lower virus counts and thus lower transmission rates.

The 2010 recommendation was adopted by 90 percent of all the countries in the world, so the WHO is confident that the new recommendations will be accepted, taught, and used worldwide. Countries such as Algeria, Argentina and Brazil have already begun the new treatment plan, administering ART at 500 CD4 cells/mm³.

The WHO believes that if all countries adopt these new recommendations into their own national HIV policies, their citizens will experience a notable boost in health benefits on both the public and individual levels. 

The 2013 recommendations bring other significant changes regarding the correct way to use ART. Now this treatment can be given to all HIV-positive children under five, all HIV-positive pregnant and breastfeeding women and all HIV-positive people who live with an uninfected partner. And treatment can be administered at any point, regardless of their CD4 count. 

Anthony Lake, Executive Director of the United Nations Children's Fund (UNICEF), explains that these new advances give women and children more access to early and safe treatment. He firmly believes that this progress will be continuous and successful enough to keep allowing organizations like the WHO and UNICEF to invest in new research and treatment advances that could possibly extend this treatment to newborn babies. 

Another advancement in the treatment recommendations allows ART to be taken in the form of single fixed-dose combination pill. This new combination will allow for a safer and easier treatment. 

The WHO is also continuing to stress the importance of ART treatment for all HIV-positive people who are also infected with active tuberculosis or hepatitis B. To help and encourage countries to improve their methods of providing HIV services, the WHO is taking it one step further in recommending that HIV services be more closely linked to other health services such as those for tuberculosis, sexual and reproductive health, treatment for drug dependence and maternal and child health.

Despite this incredible progress, there are still major challenges to this global initiative.

The WHO, UNAIDS and UNICEF released a treatment progress update that identified the groups who need the most attention. In many areas of the world, cultural beliefs and laws do not allow for men who have sex with men, drug users, transgender people and sex workers to have access to the proper treatment — even though these groups are considered high-risk and high-transmission groups of people.

In addition, the organizations need to address the many instances of people dropping out and discontinuing treatment.

Luckily, the data on ART is very encouraging and reassuring. The "Global update on HIV treatment: results, impact and opportunities" reveals data that supports the probability of the success of the WHO's new recommendation.

Based on promising data collected between 2011 and 2012 that showed an increase — the largest yet — of 1.6 million people benefiting from ART, the report predicts that with earlier use of ART, 26 million people worldwide have the potential to be eligible for the therapy.

Even more encouraging is the fact that Africa is the leading region for increased coverage, with four out of five people who received treatment in 2012 hailing from sub-Saharan Africa.

AIDS organizations around the world will not stop at anything less than success. Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), declared that, "[W]e 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."

These guidelines were presented by the WHO on the first day of the 2013 International AIDS Society conference in Kuala Lumpur.

Review Date: 
July 8, 2013