Register TodayEarn Free CME Credits by reading the latest medical news in your specialty.Sign UpKUALA LUMPUR -- New international guidelines suggest that people diagnosed with human immunodeficiency virus (HIV) be treated earlier in the course of the disease -- effectively making another 9.2 million people eligible for antiretroviral therapy, researchers said here.
Currently in the underdeveloped world, where HIV has devastated many nations, 9.7 million people out of an estimated 16.7 million who should be treated receive effective antiretroviral therapy, said Gundo Weiler, MD, PhD, medical and health policy adviser of the National German AIDS Organization in Berlin. But the impact of the new World Health Organization (WHO) guidelines will increase the number of patients who need to be treated to 25.9 million.
The major increase comes from earlier treatment -- commencing highly active antiretroviral therapy (HAART) when infected persons' CD4-positive cell counts drop below 500 cells/mm3, Weiler, who helped write the recommendations, said at the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. The previous guidelines suggested treating patients once those immune system markers fell below 350 cells/mm3.
Weiler said the 2013 WHO guidelines would result in 3 million deaths due to HIV being avoided between 2013 and 2025 when compared with 2010 guidelines. The implementation of the guidelines also would reduce new HIV infections by 36% by 2025 compared with projections using the 2010 guidelines.
The change in definition of when to commence treatment adds 3.9 million persons to the "should be in treatment" statistics. The new guidelines also expand the use of antiretroviral therapy in children. Under the old guidelines, 1.2 million children needed to be in treatment; the new guidelines expand that to 2.6 million children.
The new guidelines suggests that all HIV-positive pregnant women, regardless of CD4 count, be placed on antiretroviral therapy -- adding 700,000 people to those needing treatment.
The new guidelines also advocate immediate treatment with HAART therapy for those 3.2 million people now coinfected with tuberculosis or hepatitis B infection.
All told, the new guidelines increase the numbers of patients needing HAART by 9.2 million.
Weiler said that by increasing contributions from governments and other agencies by 10% a year, it will be possible to have those patients under treatment by 2025. But because treatment reduces infections, after 2025, the number of patients living with HIV and the number of people on treatment will begin to merge.
"Generally, in the U.S. and Canada we are already using these guidelines to treat our patients," Julio Montaner, MD, professor of medicine at the University of British Columbia, Vancouver, told MedPage Today.
"What these guidelines will do, however, is to convince doctors who are on the fence about where to begin treatment to start treating their patients earlier," Montaner said.
He also said that in Europe -- especially in countries that are experiencing economic crises -- the guidelines will help convince those health providers to initiate HAART therapy earlier. Montaner did not participate in the WHO guideline-writing process.
The new guidelines recommend: Treating adults, adolescents, and older children earlier -- starting antiretroviral therapy in all individuals with a CD4 cell count of 500 cells/mm3 or less and giving priority to individuals with severe or advanced HIV disease and those with a CD4 cell count of 350 cells/mm3 of less.Starting antiretroviral therapy at any CD4 cell count for certain populations with HIV, including people with active tuberculosis disease, people with hepatitis B coinfection with severe chronic liver disease, HIV-positive partners in serodiscordant couples, pregnant and breastfeeding women, and children younger than 5 years of age.A new preferred first-line antiretroviral regimen harmonized for adults, pregnant and breastfeeding women and children ages 3 or older. That first-line therapy should be a fixed-dose combination of tenofovir plus lamivudine or emtricitabine plus efavirenz.Support to actively accelerate the phasing out of stavudine (d4T) in first-line regimens for adults and adolescents.
The guidelines also include new recommendations for testing for HIV.
Montaner reported commercial relationships with Abbott, Gilead Sciences, GlaxoSmithKline, and Merck.
Weiler reported no disclosures.
Primary source: International Aids Society
Source reference:
World Health Organization "Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV Infection" IAS 2013.
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