GLOBAL: WHO sets new HIV treatment guidelines
NAIROBI, 30 November 2009 (PlusNews) - The World Health Organization (WHO) issued a new set of guidelines for the treatment of HIV and prevention of mother-to-child transmission (PMTCT) on 30 November.
The recommendations are intended to provide a reference for countries in setting their own national standards for HIV/AIDS treatment and PMTCT. Implementation will depend on local capacity and budgets, but the guidelines could potentially have a tremendous impact on the lives of the 33.4 million people living with HIV/AIDS.
"The widespread adoption of the recommendations will enable many more people in high-burden areas to live longer and healthier lives," said Dr Hiroki Nakatani, Assistant Director General for HIV/AIDS, TB, Malaria and Neglected Tropical Diseases at WHO.
The revised guidelines, based on new scientific evidence, raise the threshold for starting antiretroviral therapy (ART) from a CD4 count (a measure of immune system strength) of less than 200 cells per cubic millilitre - as recommended by the guidelines issued in 2006 - to a CD4 count of 350 or less, regardless of whether or not the patient is displaying symptoms.
Studies have shown that starting ART earlier reduces mortality rates, but earlier treatment will mean an average additional one to two years on antiretroviral (ARV) drugs, raising concerns about the costs for governments already struggling to meet targets set according to the previous guidelines.
The 2009 guidelines suggest greater use of laboratory monitoring, including CD4 counts and viral load testing (measuring the amount of HIV in the blood), to better manage HIV treatment and care.
WHO also advises the use of first-line ARV drugs - Zidovudine (AZT) or Tenofovir (TDF) - rather than Stavudine (d4T), which has been widely used in developing countries because of its lower cost, but produces more serious side effects.
In line with several recent clinical studies that have demonstrated the efficacy of ARVs in preventing HIV transmission from mother to child during breastfeeding, the new guidelines call on all HIV-positive pregnant women to begin ARV treatment at 14 weeks of pregnancy and continue until they stop breastfeeding.
Previous guidelines recommended that ARVs be provided to HIV-positive pregnant women only in the third trimester (beginning at 28 weeks). The new guidelines encourage HIV-positive mothers to exclusively breastfeed their infants for the first six months of life. Other foods should be introduced at that point, but WHO suggests mothers continue breastfeeding up until 12 months.
"We are sending a clear message that breastfeeding is a good option for every baby, even those with HIV-positive mothers when they have access to ARVs," said Daisy Mafubelu, WHO's Assistant Director General for Family and Community Health.
WHO is working with UNAIDS, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US President's Emergency Plan for AIDS Relief (PEPFAR), to provide detailed costings for implementing the new recommendations.
Saira Stewart, from WHO's HIV/AIDS Department, told IRIN/PlusNews that treatment costs would initially rise, but then decline as starting ART earlier would prevent new HIV infections and opportunistic diseases like tuberculosis.
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