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WHO Issues New Guidelines Calling for Earlier Treatment of HIV

Monday, October 28th, 2013

HIV (human immunodeficiency virus) infects immune system cells, impairing or destroying their function. In the early stages of HIV infection, there may be no symptoms, but as it progresses, immune system function deteriorates, rendering the person more vulnerable to other infections. AIDS (acquired immunodeficiency syndrome) is the most advanced stage of HIV. Once a person becomes infected with HIV, it usually takes about 10-15 years to develop AIDS. This amount of time can be lengthened even more with antiretroviral drugs.

HIV can be transmitted in several ways, including unprotected sexual intercourse (vaginal or anal), transfusion of contaminated blood, passed from mother to infant during pregnancy, childbirth, or breastfeeding, and through sharing contaminated needles. Over the past 30 years, HIV has claimed over 25 million lives. HIV infection is diagnosed through blood tests than detect the presence of HIV antibodies. While there is no known cure for HIV infection, antiretroviral drugs control the virus and allow many people with HIV to lead productive and healthy lives.

This past summer, WHO (World Health Organization) issued new recommendations for earlier HIV treatment than had been used previously. The new guidelines call for offering ART (antiretroviral therapy) earlier on in the infection. This is in response to new research that shows that when people receive ART earlier, they live longer, healthier lives, and have a lower chance of transmitting the infection to others by lowering the amount of virus in the blood.

The previous guidelines, which were set in 2010, recommended offering ART once the patient’s CD4 cell count fell to 350 cells/mm3 or less. 90% of all countries have adopted these guidelines. However, this year, the WHO changed their recommendation to beginning ART at 500 cells/mm3 or less, before immune system function weakens.

WHO also now recommends providing ART to all children under five years of age, all pregnant and breastfeeding women with HIV, and all people with HIV who are in a relationship with an uninfected partner – regardless of CD4 cell count.

Of course, in spite of advances in treatment and more enlightened recommendations, challenges remain. The number of HIV-positive children receiving ART has not increased as quickly as the number of adults receiving the treatment. Another problem is that certain people, such as intravenous drug users, sex workers, and transgender people often encounter cultural or legal barriers that stop them from getting treatments that are more readily available to others. In addition many people, for various reasons, discontinue treatment. This is a prevalent problem that needs to be addressed.

In spite of these challenges, the fact remains that today almost 10 million people are receiving lifesaving treatments for HIV infection. The goal now is to continue pushing to make treatment available to the over 10 million more who need it, and increase awareness of prevention and treatment methods worldwide.

– Yvonne S. Thornton, M. D., M. P. H.

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Have We Stopped the AIDS Virus in Its Tracks?

Thursday, June 21st, 2012

Although we haven’t heard as much about the AIDS virus lately, that doesn’t mean it has stopped its deadly spread.  Researchers have been working feverishly for years now to come up with a cure or a treatment that could stop the virus and save lives.  For some, expensive treatments seemed to work, keeping the virus at bay for years, but for those living in poverty, treatments like that were only a dream.  Now though, new antiretroviral treatment has been developed at a price that will make it available to even low income people with HIV.

Currently, there are 56,000 Americans infected with AIDS every year and more than 30 million living with it worldwide.  In Africa, where poverty and AIDS are prevalent, a study of 500 HIV-infected women found that Nevapirine, a new and much cheaper treatment, was just as effective at slowing the virus as more expensive medicines like  Lopinavir and Ritonavir.  However, the newer, less expensive drug had 14% of its users stop treatment because of adverse side effects and toxicity.  Also, there was more drug resistance with Nevapirine compared to the more expensive medications.  With that said, nevaprine is an effective, affordable first-line alternative for the treatment of HIV. There are now even more drugs reaching the final testing stages and getting FDA approval that are effective enough to decrease the levels of the AIDS virus to undetectable levels in about 80% of their trial participants.  Recent discoveries of the delta-32 mutation to the gene that encodes CCR5 were found to block HIV receptors, rendering it incapable of multiplying.  Researchers have now found a way to mimic this mutation and, in a sense, cure patients with the use of their small molecule drug called Maraviroc.  Maraviroc (brand name, Selzentry) was approved in 2007 as an antiretroviral drug in the CCR5 receptor antagonist class used in the treatment of HIV infection and is now being tested for its safety and efficacy. More and more drugs are being developed with this break-through in mind.  Once each one has been approved for public consumption, many others will be able to create even less expensive options and get the drugs to the areas where they are needed most.

This flurry of discovery, innovation, and resourcefulness has made the AIDS epidemic suddenly much more manageable.  Although we haven’t quite taken the last step to stop all 2 million AIDS deaths each year, it seems we are on the cusp of putting this virus behind us.

 

– Yvonne S. Thornton, M. D., M. P. H.

 

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