Cape Town - Local scientists and Aids activists have welcomed the new treatment guidelines on HIV that could see HIV-positive patients getting treatment at an early stage of infection, but have warned that the protocol must be executed properly to avoid a shortage of drugs.
Early this week the World Health Organisation recommended that people start getting antiretrovirals when their CD4 immune cell count was 500, up from 350. The CD4 count is often used to determine the stage of the disease. When antiretrovirals were first introduced in South Africa the recommended threshold was 200, indicating fewer immunity cells remaining.
The new protocol means treatment should start at a much earlier stage of infection. Along with this, the world health body also recommended that treatment be given to all infected pregnant women and children under five – as well as other vulnerable groups, regardless of their CD4 count.
Vuyiseka Dubula, Treatment Action Campaign general secretary, applauded the new recommendations, saying early treatment would not only reduce mortality, but would also reduce chances of transmission.
“The earlier a person starts ARVs, the fewer the chances of HIV-related opportunistic infections like tuberculosis and pneumonia. This should be more of an incentive for testing because tested people will be treated immediately rather than having to wait until they are sick, which in many cases is too late. This is a chance to ensure that the health system catches people early enough.”
Dubula said the new guidelines would accelerate efforts to reduce new HIV infections, but if the implementation was not done properly the ARV programme could be overwhelmed and there could be shortages of drugs.
The health system would also need to be flexible and innovative, possibly delivering drugs to patients rather than expecting them to come to the clinics very month.
“We will need additional people to cater for the new additional patients in the system.”
Professor Linda-Gail Bekker, head of the Desmond Tutu HIV Centre at UCT, said that while people who wanted to start treatment early could now do so, unless the rollout was done aggressively the response would not be enormous.
“Emerging data shows that HIV causes inflammatory complications from the get go. Earlier viral control will reduce this. The drugs are now much less toxic and easier to take, which will help.”
Bekker said the early introduction of ARVs might be particularly good for couples when one person was HIV-positive, but without enough human resources to go after individuals who should now take the treatment, the impact could be minimal.
Joe Maile, spokesperson for Health Minister Aaron Motsoaledi, could not confirm when the government would adopt the new guidelines. “We will review it and see what it means for South Africa. We will have to look at various factors including capacity and financial issues for instance.” - Cape Argus