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WHO Greets World AIDS Day 2009 With New HIV Treatment Recommendations

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Published: Dec 3, 2009 8:00 am
WHO Greets World AIDS Day 2009 With New HIV Treatment Recommendations

On November 30, 2009, the eve of World AIDS Day, the World Health Organization (WHO) released new recommendations on treatment, prevention, and infant feeding with respect to HIV. It is hoped that implementation of these new guidelines will improve the health of HIV-positive individuals, decrease the number of new HIV infections each year, and ultimately, save lives around the world.

“These new recommendations are based on the most up to date, available data,” said Dr. Hiroki Nakatani, WHO Assistant Director General for HIV/AIDS, tuberculosis (TB), Malaria and Neglected Tropical Diseases, in a WHO press release. “Their widespread adoption will enable many more people in high-burden areas to live longer and healthier lives.”

The 2009 recommendations replace those previously drafted in 2006.

In 2006 patients were advised to begin antiretroviral treatment (ART) after the onset of HIV symptoms or when their CD4 (white blood cell) count dropped below 200 cells per microliter.

However the new recommendations have increased this threshold number to 350 cells per microliter regardless of symptoms or pregnancy.

Earlier onset of treatment will lower risk of HIV and TB transmission, boost patients’ immune systems, and lessen the risk of HIV-related death and disease.

The drug stavudine (Zerit) has been found to have long-term irreversible side effects such as peripheral neuropathy, a nerve disorder; and lipoatrophy, characterized by fat loss in certain areas of the body.

Therefore the WHO recommends that stavudine be phased out of treatment regimens, and replaced with less toxic and equally effective drugs such as Viread (tenofovir) and zidovudine (Retrovir).

Currently, stavudine is frequently used in developing countries as a first-line therapy due to its low cost, widespread availability, limited need for laboratory monitoring, and initial tolerability by the body.

The latest recommendations also include new strategies to reduce mother-to-child transmission and improve child survival. It is now recommended that HIV-positive pregnant women begin ART at 14 weeks, rather than the previously recommended 28 weeks.

Additionally in 2006, there was insufficient information regarding the effects of ART drug use during breastfeeding.

Newer studies have since shown that ART should continue throughout the breastfeeding period, until the baby is 12 months old. As long as the mother is receiving antiretroviral drugs, the infant will have a decreased risk of acquiring HIV as well as a greater chance of survival.

This is welcomed news, for in some cases, breastfeeding is necessary due to financial and environmental constraints. Also some cultures regard breastfeeding as the only acceptable way to nourish an infant.

Now under the 2009 recommendations the benefits of breastfeeding are not restricted to babies with HIV-uninfected mothers.

“In the new recommendations, we are sending a clear message that breastfeeding is a good option for every baby, even those with HIV-positive mothers, when they have access to antiretroviral drugs,” said Daisy Mafubelu, the WHO Assistant Director General for Family and Community Health, in the November 30 press release.

With widespread use of these new mother-to-child guidelines, the WHO expects to see mother-to-child HIV transmission risk decrease from 32 percent to five percent or lower.

The 32 percent comes from a 2005 report by the Centers For Disease Control (CDC) describing the estimated transmission risk for mothers who went without ART and opted to breastfeed.

Lastly, in the new recommendations the WHO stresses the need for increased laboratory monitoring and greater access to CD4 testing. However, ART should not be denied in cases where monitoring tests are not available.

Nevertheless there are several obstacles to the implementation of the recommendations – most notably limited access to and availability of treatments in developing countries.

The 2009 “Towards Universal Access” report released by the WHO, UNICEF, and UNAIDS reported that more than four million people had access to ART in low- and middle-income countries by the end of 2008.

Though this is a tenfold increase from five years prior, it still only represents 42 percent of the estimated 9.5 million people in need of treatment in 2008.

So far the WHO has released three sets of “Rapid Advice” documents addressing new recommendations for adults and adolescents, pregnant women and infants, and infant feeding.

The full guidelines are expected to be released in 2010.

For more information, please see the WHO “Rapid Advice” recommendations or the November 30 WHO press release. More on prevention of mother-to-child transmission can be found at the related AIDS Beacon article.

Photo by KittenPuff1 on morgueFile – some rights reserved.
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3 Comments »

  • wessel said:

    WE NEED ACURE FOR HIV/AIDS

  • HIV aware said:

    This is good news, however the BEST solution to the problem is awareness and education which leads to prevention.

  • Charles Hemba said:

    In the fight against HIV/AIDS, it is known that the drugs so far that have been invented are basically to reduce or impede the action of the enzyme reverse transcriptase which converts viral RNA into viral DNA which subsequently attaches itself to the human cell DNA. Can’t research be able to work on the viral RNA/DNA to see to their reconfiguration so that they become less harmful to the human system because for now the cure is the only way out.