Important note: Information in this article was accurate in 2008. The state of the art may have changed since the publication date.
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Voice of America - October 27, 2008
Joe De Capua
Washington
A new study says those infected with HIV, the AIDS virus, should receive drug treatment much sooner than is currently recommended. It says those who delay treatment until their immune systems are badly weakened are 74 percent more likely to die sooner than those who start treatment earlier.
US and Canadian researchers based their findings on patient records. The rationale behind delaying treatment was to spare patients the side effects of the anti-retroviral drugs.
Currently, treatment is based on the number of CD4 immune system cells. The standard treatment had been a count of 200 per milliliter of blood and was recently raised to 350. Now, many say treatment should begin when the CD4 count reaches 500 - a significant difference.
Mark Heywood is deputy chairperson of the South African National AIDS Council and director of the AIDS Law Project. From Braamfontein, he spoke to VOA English to Africa Service reporter Joe De Capua about the findings.
"For some time we have suspected this. I've spoken to many medical doctors who have wanted the initiation point for treatment to be raised. They've argued for a CD4 counts of 350. It's obviously important news and it's obviously important information, but it has very, very significant implications, particularly for developing countries.... What it means in a country like South Africa is that whereas at present the starting point for anti-retroviral therapy is when people have a CD4 count of 200 or 250, this would mean double the numbers of people who are currently considered to be needing treatment to be eligible. And that will put a strain on the healthcare system. And that will put a strain on the affordability of treatment. So, whilst it is welcome, it will present us with major challenges," he says.
A CD4 count of 200 had been used as the transition point at which a patient was considered to have AIDS and not just be HIV positive. "What it means is that either they are sick with opportunistic infections, such as TB, sometimes fungal infections, sometimes pneumonias, or that they are very vulnerable to being ill because their immune system has now become very, very weakened by the HIV virus. But obviously the thinking is saying, well, we don't want people to get to that level of immune weakness before they go on to treatment. The thinking seems to be to say let's preserve health. Let's start treatment at a point before the immune system has been weakened, rather than waiting for the weakening and then trying to recover lost ground," he says.
If the CD4 threshold is raised to 500, Heywood says it would mean about two million people in South Africa would need treatment. Currently, about one million South Africans receive anti-retroviral drugs. "It is very challenging because...wherever you are in the world, ethically there's a responsibility to try to get to people the best and most appropriate medical treatment based upon protocols of treatment around which there is scientific consensus. So, if there's scientific consensus on this, then there's a lot more hard work to be done," he says.
Heywood and the AIDS Law Project had waged a legal battle against the South African government about five years ago to roll out a national AIDS treatment program. But he says at that time the CD4 threshold had not been part of the legal argument. "In those days, the issue of when to start treatment didn't come up.... Our argument was just that people with HIV had a right to treatment. That they had the same right to access treatment as say people in the United States or people in Europe. Once we had achieved an agreement from that principle, then of course the clinicians and the scientists looked at the question of what point people should start treatment. And at that point they said a CD4 count of 200," he says.
Heywood says he hopes donor nations will increase funding for AIDS drugs to meet a new treatment threshold, despite the current global economic crisis.
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