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Updated: July 3, 2013 03:07 IST

WHO recommendations call for early anti-retroviral therapy

Afshan Yasmeen
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The World Health Organisation’s (WHO) new guidelines for treatment of HIV has brought hopes of leading a healthy and longer life for the 2.49 lakh people living with HIV in Karnataka, as it mandates starting treatment while the immune system is still strong.

The new recommendations, released at the inaugural day of the International AIDS Society 2013 conference in Kuala Lumpur on Sunday, encourage all countries to initiate anti-retroviral therapy (ART) treatment in adults living with HIV when their (cluster of differentiation 4) CD4 cell count falls to 500 cells/mm³ or less. CD4 cell count is a scale to measure the person’s immune system.

The earlier WHO recommendation, set in 2010, was to offer treatment at 350 CD4 cells/mm³ or less. Almost all the countries have adopted the 2010 recommendation. Early treatment will substantially reduce the risk of HIV transmission to others.

The new HIV treatment guidelines have been based on recent evidence indicating that early ART will help people with HIV to live longer, healthier lives. The move could avert an additional 3 million deaths and prevent 3.5 million more new HIV infections between now and 2025 globally, according to WHO.

“This can both keep them healthy and lower the amount of virus in the blood thereby reducing the risk of passing it to someone else,” said H.N. Ravindra, Deputy Director for Blood Safety in Karnataka State AIDS Prevention Society (KSAPS).

These guidelines can help in reducing the overall prevalence rate that stands at 0.63 per cent in Karnataka (according to 2010-2011 surveillance data), he said.

D.R. Sunil Kumar, National AIDS Control Organisation’s (NACO) Regional Coordinator for Karnataka and Kerala, told The Hindu that it may take some time for India to adopt the new guidelines as NACO has to integrate the new recommendations with the country’s national HIV policy.

NACO’s National Resource Group is likely to meet within a month, he said.

“The changed treatment regime will definitely increase the patient load and have additional financial implications. All these aspects have to be discussed before the new guidelines are enforced,” he explained.

Financial implication

About the additional financial implications in the State, Dr. Kumar said: “NACO has approved Rs. 83.7 crore for Karnataka for 2013-2014. Although the new guidelines will mean more expenses, the grants are not likely to change as HIV drugs and CD4 testing kits are supplied directly by NACO to KSAPS.”

In Karnataka, the cumulative deaths due to HIV from 2004 (when ART was started) till date stand at 28,000. “This number only pertains to the total number of reported deaths. There could be many more who would have succumbed to the disease and these deaths go unreported as people would not have registered for treatment,” Dr. Kumar said.

This apart, the new recommendations include providing ART — irrespective of their CD4 count — to all children with HIV aged under five , all pregnant and breastfeeding women with HIV and to all HIV-positive partners where one partner in the relationship is uninfected.

WHO’s old guideline to provide ART to all people with HIV with active tuberculosis or with Hepatitis B disease remains the same in the new set of recommendations.

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