WHO issues new HIV/AIDS treatment guidelines

Dec 1 2009

The WHO on Monday issued new recommendations that patients living with HIV/AIDS begin receiving antiretrovirals (ARVs) earlier than current HIV treatment advice suggests, the Associated Press reports.

The recommendations - an update to 2006 treatment guidelines - come after several studies showed "people with HIV who start drugs earlier than recommended have a better chance of surviving," according to the news service.

The AP continues: "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."

"Still, WHO's advice raises questions about how countries and donor agencies will pay for the lifelong AIDS treatment," the news service writes. "About 4 million people worldwide are receiving AIDS drugs, but another 5 million are still waiting in line. With its new recommendations, WHO guessed that another 3 to 5 million people now qualify for the drugs." The article examines the reactions of several international HIV/AIDS experts to the WHO guidelines (Cheng, 11/29). The WHO estimates there are 33.4 million people are living with HIV/AIDS, and 2.7 million new HIV infections occur each year.

"These new recommendations are based on the most up to date, available data," Hiroki Nakatani - WHO assistant director general for HIV/AIDS, TB, Malaria and Neglected Tropical Diseases - said in a WHO press release. "Their widespread adoption will enable many more people in high-burden areas to live longer and healthier lives" (11/30).

The WHO recommendations also promote pregnant women living with HIV/AIDS to begin treatment with ARVs earlier in their pregnancy and throughout the breastfeeding period, which should continue for 12 months, Reuters reports (Nebehay, 11/29).

"In the new recommendations, 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," Daisy Mafubelu, WHO's assistant director general for family and community health, said in a WHO press release (11/30).

The WHO also recommended that "[c]ountries should phase out the use of Stavudine, the most widespread antiretroviral, because of [what the organization called] 'long-term, irreversible' side-effects in HIV patients including wasting and a nerve disorder," Reuters reports.

"Stavudine, widely available in developing countries as a first-line therapy, is relatively cheap and easy to use, according to the United Nations agency," the news service writes. The reported side-effects of the drug, however, led WHO to recommend "'…countries progressively phase out the use of Stavudine as a preferred first-line therapy option and move to less toxic alternatives such as Zidovudine (AZT) or Tenofovir (TDF).' These are 'equally effective alternatives.'"

"Of over 4 million people globally who take antiretrovirals, about half are on a regimen containing stavudine, down from 80 percent in 2006 when the WHO first said countries should envisage moving away from it because of its long-term effects, according to Dr. Siobhan Crowley of WHO's HIV/AIDS Department," Reuters writes (11/29). Reuters also features a factbox summarizing the updated WHO HIV Treatment Guidelines (Nebehay [2], 11/29).