WHO: Treat HIV Patients Sooner

People with HIV should initiate antiretroviral (ARV) therapy earlier rather than later in order to reduce the risk of death and disease, the World Health Organization said on Monday.

ARV therapy should begin when a patient has a CD4 threshold of 350 cells/cubic millimeter, regardless of symptoms, WHO said. In 2006, WHO had recommended that patients begin therapy at 200 cells/cubic millimeter. Since that time, several studies have shown earlier ARV treatment reduces rates of death and disease, WHO said.

About 4 million people with HIV/AIDS worldwide are receiving ARVs, and 5 million more people are in need of them. Under the new higher treatment threshold, an additional 3 million to 5 million patients will need the drugs.

HIV-positive pregnant women should also begin earlier treatment to prevent mother-to-child infection, WHO said. Pregnant women should begin ARVs at the 14th week and continue through the breastfeeding period, WHO said. WHO's 2006 guidelines had recommended ARVs at the 28th week, or third trimester, and evidence that ARVs could reduce HIV risk during breastfeeding was still insufficient at that time.

Adopting WHO's treatment guidelines will allow "many more people in high-burden areas to live longer and healthier lives," said Hiroki Nakatani, WHO's assistant director general for HIV/AIDS, TB, malaria and neglected tropical diseases.

Boosting ARV access in poor countries -- especially those with weak infrastructure, limited human and financial resources, and poor integration of HIV interventions within maternal and child health services -- is fraught with challenges, WHO acknowledged. Even under current guidelines, some African clinics are turning away new patients. Experts say the earlier treatment recommendations could add billions of dollars to global AIDS-control costs.

In addition, convincing HIV-positive people to begin treatment before they are symptomatic could be difficult.

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