Experts cautious of new HIV treatment guidelines

A leading South African AIDS expert has cautioned that new guidelines on HIV treatment may be a distraction to the country’s ongoing treatment efforts.

Reacting to the latest World Health Organization guidelines on HIV treatment, Prof Francois Venter, the Deputy Director of Wits University’s Reproductive Health and HIV Institute, told Health24 that the current treatment system needed to be fixed first.

The new WHO recommendations, issued at the recent 7th IAS Conference in Malaysia, pushes for people with a CD4 count of 500 or less to be put on antiretrovirals (ARVs).

A CD4 is the amount of healthy cells per cubic millimetre in a person’s blood, and gives a good idea of how far the HI virus has developed in a person.

The guidelines also calls for ARVs for all pregnant and breastfeeding women, people with hepatitis B or tuberculosis, children under the age of five, and people with HIV-negative sexual partners to begin treatment.

However, with the shaky state of South Africa’s HIV treatment system, the WHO recommendations have been cautiously met, as the new guidelines are suited to a well-oiled health system, not one with drug stock-outs, as has been occurring at treatment sites throughout South Africa.

When to start HIV treatment?

“If it was me, I’d first ensure there are no drug stock-outs and that everyone needing therapy is getting it,” Prof Venter said.

Venter says he would only then start talking about raising the CD4 treatment bar, or simply treating everyone irrespective of their CD4 count.

The Department of Health, meanwhile, has accepted the WHO’s proposals, announcing they are considering ways to implement them.

But the biggest obstacle to mass treatment in South Africa, however, is that most HIV-positive people don’t know, or don’t want to know, they’re living with the HI virus.

“I’d focus hard on testing people and treating them at or near 350 CD4, while also aggressively addressing the needs of pregnant women and TB patients,” added Venter.

A CD4 count of 350, which was recently introduced in South Africa, is currently the optimal time to start ARVs. Prior to this, and since the first drug regimens were made available in the country, the accepted CD4 level for treatment was 200.

As far back as 2011, Venter already stressed that if all HIV-positive people started ARVs at a CD4 count of 350, this would have a massive effect on transmission of the virus between partners.

There are an estimated 5.9 million South Africans currently living with HIV, according to the Joint United Nation Programme on HIV/AIDS (UNAIDS). And these are only the ones we are aware of!

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