New WHO rule requires Aids drugs be started earlier

The World Health Organisation (WHO) has called on countries to initiate treatment in adults living with HIV/Aids when their CD4 cell count falls to 500 cells/mm³ or less, when their immune systems are still strong.
Anti-retroviral drugs
Anti-retroviral drugs

The World Health Organisation (WHO) has called on countries to initiate treatment in adults living with HIV/Aids when their CD4 cell count falls to 500 cells/mm³ or less, when their immune systems are still strong.

This is according to the new guidelines on the diagnosis of human immunodeficiency virus (HIV) infection, the care of people living with HIV and the use of anti-retroviral drugs for treating and preventing HIV infection.

Treatment and care

The new guidelines replace the previous WHO recommendation, set in 2010, which recommended starting anti-retroviral treatment at 350 CD4 cells/mm³ or less.

The guidelines are structured along the scale of HIV testing, care and treatment. 

The recommendations were highlighted during the opening of a two-day workshop of health  practitioners in Kigali, yesterday.

In the new guidelines, a comprehensive guidance is provided on using ARV drugs across different age groups, pregnant and breastfeeding women, adolescents, children and key populations. 

The guidelines would also consolidate and update clinical service delivery.

Meg Doherty, the WHO coordinator of Treatment and Care in the Department of HIV/Aids, said they based the recommendation on evidence that treating people with HIV earlier, with safe, affordable, and easier-to-manage medicines can keep them healthy and lower the virus count.

It in effect reduces the risk of passing on the virus to someone else.

“If countries can integrate these changes within their national HIV policies, and back them up with the necessary resources, they will see significant health benefits,” Doherty said.

The new recommendations also include providing antiretroviral therapy, irrespective of one’s CD4 count.  

It should apply to all children with HIV under five years of age, pregnant and breastfeeding women with HIV, and discordant couples.

Anthony Lake, the Unicef executive director, said advances like these allow children and pregnant women to access treatment earlier and more safely, and moves us closer to our goal of an Aids-free generation.

Mark Dybul, the executive director of the Global Fund to Fight Aids, tuberculosis and malaria, said the new WHO guidelines were timely in view of the rapid progress that has been made in expanding programmes for prevention and treatment.

“This is an example of how the Global Fund and WHO work together to support countries as we move toward removing HIV as a threat to public health,” he said.

Implementing guidelines

Rwanda is ahead in many recommendations provided by WHO, according to Dr Sabin Nsanzimana, the coordinator of HIV and Sexually Transmitted Infections Care and Treatment Department in the Rwanda Biomedical Centre.

Nsanzimana said Rwanda has registered 48 per cent progress in eliminating new infections and has reduced the number of infected people from five to two per hour in the last five years.

Speaking at the workshop, the Minister for Health, Dr Agnes Binagwaho, urged countries to push for the implementation of the new guidelines despite budgetary constraints.

“We are here to share experience and find new ways to slow down this disease. 50 per cent of the people living with HIV/Aids in the world need treatment. We need determination and meetings in order to come up with solutions to this disease,” Dr Binagwaho said.

More than 90 per cent of persons infected with HIV/Aids can now access ARVs that are now available in almost all health facilities across the country.

In Rwanda, 3.0 per cent of the general population, aged 15-49, has HIV, whose prevalence rate is higher among women (3.7 per cent) than among men (2.2 per cent).

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