New Guidelines For HIV/AIDS Treatment

Jul 11, 2013 | Naomi Nkinsi | Research & Policy

According to the World Health Organization (WHO), earlier administration of antiretroviral treatments may be our newest weapon in the war against HIV/AIDS. Acquired Immune Deficiency Syndrome (AIDS) is a potentially life-threatening chronic condition caused by the Human Immunodeficiency Virus (HIV) which damages the immune system, interfering with your body’s ability to fight disease. Worldwide, nearly 35 million people have died due to AIDS since the epidemic began and an estimated 34 million people around the globe were living with HIV at the end of 2011. The global burden of this disease has been felt heavily, especially in Sub-Saharan Africa and Southeast Asia where case counts are amongst the highest. The new WHO guidelines are said to be capable of saving over 3 million lives globally. This news comes as a beacon of hope for the many suffering from the far-reaching effects of this disease.

Although much progress has been made towards an HIV vaccine, a major roadblock in eradicating the disease is the lack of a cure. Today, those who test positive for HIV are put on a variety of drugs (called antiretrovirals) to control, rather than destroy, the virus and prevent the progression of the disease to AIDS. These drugs must be taken in a cocktail of two or sometimes three drug combinations to prevent viral strains from becoming resistant to available treatment methods. These powerful medications are known to cause severe side effects like nausea, diarrhea, weakened bones, and abnormal heartbeats. Regardless, antiretroviral treatments remain the best method to increase the lifespans of those who, in the past, would have been taken by the disease much earlier.

Since we can now treat those suffering from HIV/AIDS, many still wonder, “Why are so many people still dying from this disease?” It turns out that, in many cases, these effective drugs were being administered too late in the disease progression. In order to address this issue, the WHO released new antiretroviral treatment guidelines on June 30 that call for earlier antiretroviral therapy (ART) for those testing positive for HIV/AIDS. WHO claims it has evidence indicating that earlier ART will help those with HIV live longer, healthier lives as well as substantially reducing the risk of transmitting HIV to others. The new treatment guidelines could avert an additional 3 million deaths and as many as 3.5 million new HIV infections between now and 2025.

The previous WHO recommendation, set in 2010, stated that ART should be offered to individuals with a CD4 count of 350 cells/mm3 or less. CD4 counts that low are an indication of an extremely damaged immune system. Since CD4s are a type of white blood cell that fight infections, measures of these cells from blood draws are a direct indication of your immune system strength. Normal CD4 counts range from 500 to 1000 cells/mm3, so you can see why a count of 300 would be considered significantly low. Rather than waiting for an individual’s immune system to collapse to start ART, the WHO recommends treatment when CD4 counts hit 500 cells/mm3 and the person still appears relatively healthy. Also, the recommendation goes further to say that all adults starting ART should be offered the same daily single fixed-dose medication containing two or more active drugs in a single pill rather than the usual cocktail of multiple pills. This single pill alternative is easier to take and is safer to use on adults, children, teenagers, and pregnant women alike.

In addition to administering necessary medications much earlier, these new regulations will allow 26 million new people to start ART, an increase of 9.2 million from 2010. This sounds like a huge accomplishment. Some say, however, that we are not doing enough. Dr. Arthur Amman from the University of California San Francisco Medical Center says that these new regulations are dangerously limited. The prominent immunologist suggested to the Los Angeles Times that that rather than measuring a patient’s CD4 count, doctors should just begin treatment after a positive diagnosis. He implies that keeping patients away from medication that is known to show results is unfair, but the WHO states that there is no evidence to support this method of testing and treating patients.

According to UNICEF Executive Director Anthony Lake, “Advances like these allow children and pregnant women to access treatment earlier and more safely, and move us closer to our goal of an AIDS-free generation.” Even though the popular media has had a part in making HIV/AIDS appear as a disease only affecting those in developing countries and myths about certain races being immune to infection persist, the fact remains that everyone, is capable of contracting HIV/AIDS, regardless of race, sex, gender, class, sexual orientation, or current location. To put things in perspective, in 2009, the CDC reported that 1.1 million people living in the U.S. have HIV. Reportedly, approximately 18 percent of these people do not know that they are infected.

HIV is most commonly transmitted through sexual contact, meaning that abstinence from sex is the most effective way to prevent becoming infected. If this doesn’t sound like a likely path for you (as with many adults), latex condoms (used correctly) and testing for the virus with each new sexual partner significantly reduces your risk of becoming ill. The CDC recommends refraining from sharing needles and other blood contaminated items such as razors to prevent the spread of HIV/AIDS. 

 

Sources:

Balukjian, Brad . "Do new HIV therapy guidelines go far enough?." Los Angeles Times. 06 07 2013: n. page. Print. <http://www.latimes.com/news/science/sciencenow/la-sci-sn-hiv-guidelines-....

"HIV, AIDS, and the CD4 Count." WebMD:HIV & AIDS Health Center. <http://www.webmd.com/hiv-aids/cd4-count-what-does-it-mean>.

United States. Centers of Disease Control and Prevention (CDC). HIV/AIDS. Atlanta: , 2013. Web. <http://www.cdc.gov/hiv/>.

United States. Mayo Clinic. HIV/AIDS. 2012. Web. <http://www.mayoclinic.com/health/hiv-aids/DS00005>.

World Health Organization (WHO). HIV/AIDS. Geneva: , 2012. Web. <http://www.who.int/hiv/en/>.

World Health Organization (WHO). WHO issues new HIV recommendations calling for earlier treatment. Geneva: , 2012=3. Web. <http://www.who.int/mediacentre/news/releases/2013/new_hiv_recommendation....

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