HIV Drugs Should Be Initiated Earlier, Says UN

All HIV-positive people with a CD4+ T-cell count of 350 cells/mm3 or lower should begin antiretroviral therapy (ART), the World Health Organization said on Monday. WHO released the first revision to its ART recommendations in four years at the 18th International AIDS Conference in Vienna. WHO's revised ART guidelines reiterate advice from 2009 that treatment should begin earlier.

"All adolescents and adults including pregnant women with HIV infection and CD4 counts of 350 cells/mm3, should start ART, regardless of the presence or absence of clinical symptoms," WHO advised. "Those with severe or advanced clinical disease (WHO clinical stage three or four) should start ART irrespective of their CD4 cell count."

WHO recommendations favor simplified first- and second-line ART regimens of low toxicity and in fixed doses. Initial ART should contain a non-nucleoside reverse transcriptase inhibitor, either nevirapine or efavirenz, plus two nucleoside reverse transcriptase inhibitors, one of which should be lamivudine or emtricitabine and the other zidovudine or tenofovir, the report said.

"Countries should take steps to progressively reduce the use of stavudine (d4T) in first-line regimens because of its well-recognized toxicities," WHO said.

Patients who initiate treatment at a CD4 count of 350 or less will be exposed to an additional one or two years of ART, its side effects and risk of viral resistance, WHO acknowledged. The new recommendations, therefore, "may require more laboratory monitoring than current regimens," the agency said.

To view WHO's newly revised antiretroviral recommendations, visit: http://whqlibdoc.who.int/publications/2010/9789241599764_eng.pdf.

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