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WHO: Better HIV Antiretroviral Strategies Needed

  • Joe DeCapua

Gilead Science's Truvada combination antiretroviral pill that's taken once daily.

Gilead Science's Truvada combination antiretroviral pill that's taken once daily.

The World Health Organization says comprehensive HIV treatment strategies are needed in developing countries to overcome stigma and discrimination. It says there are a number of vulnerable groups unable to get full access to antiretroviral drugs.

Recent studies have shown that antiretroviral drugs not only extend the lives of people infected with HIV, but can also prevent infection in the first place. It’s a strategy known as “treatment as prevention.” It now means countries have the potential to greatly slow the spread of HIV by using the drugs as a prophylaxis. However, often those in need of HIV treatment and prevention are unable to receive them because of their social status.

“We’ve seen in many countries that there remains stigma against certain population groups. And in some countries these behaviors of these groups are criminalized. Being a sexworker in many African countries is criminal behavior. Being an MSN in some countries is criminalized and obviously injection drug use is,” said Dr. Gottfried Hirnschall, director of the WHO’s HIV/AIDS Department.

MSM is an acronym for men who have sex with men, one of the WHO’s and UNAIDS’ official groups of vulnerable people.

“We see barriers for these individuals to access services. And we obviously see that as a consequence in many places these groups have higher infection rates. They have higher mortality, etcetera,” he said.

Another part of a comprehensive strategy includes the question of when to start treatment. In the early days of antiretrovirals, the drugs were usually given to people when their immune systems had collapsed and were being attacked by opportunistic infections. The state of health is measured by the CD4 count. That is the number of particular immune cells a person has.

Hirnschall says, in recent years, the recommendation has been to start people on treatment much earlier.

“If you start as soon as possible – and that’s what’s happening now in the U.S. with the policy change that just took place – you may have a benefit to the patient. WHO now recommends initiation of treatment below a CD4 cell count of 350, which means that the immune system has already some signs of weakening, but that the patient is still not very sick yet,” he said.

By providing earlier treatment, many opportunistic infections could be avoided.

Two recent studies have proven the treatment as prevention strategy. One looked at discordant couples, where one person is HIV positive and the other is not. The drugs were 96 percent effective in preventing the HIV negative person from being infected.

Another study indicated the effectiveness of PrEP or preexposure prophylaxis.

“Even if you give drugs prior to exposure – in other words to HIV negative persons – referred to as preexposure prophylaxis – you may also protect this person from becoming infected. So the whole field of the use of antiretrovirals has become more and more exciting, but at the same time more complex,” said Hirnschall.”

The WHO official says it would cost more in the short-term to get more people on antiretrovirals sooner, probably billions more. However, he says in the long-term, the cost will drop and lives will be saved.

“You will have quite impressive reductions of both mortality and new infections. So we estimate over a period until 2020 more than 12 million new infections could be averted and 7.4 million deaths could be also averted. So in other words, yes, you need to invest. You need to front-load the resources, but you’re buying something for it,” he said.

Dr. Hirnschall says the World Health Organization is developing what are called consolidated guidelines. The aim is to help developing countries form care and treatment strategies for vulnerable groups.