At the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention held last month in Kuala Lumpur, Malaysia, the World Health Organization (WHO) announced the newest revisions to its HIV treatment guidelines. These revisions increase the populations who should immediately be given access to antiretroviral treatment (ART) to include:
- Any person living with HIV whose CD4 t-cell count per cubic milliliter of blood falls below 500 (which is bottom of a normal, healthy range)
- All children living with HIV under five years old
- All pregnant and breastfeeding women living with HIV
- All people living with HIV who have an uninfected partner Treating people living with HIV earlier, is a way that is easily managed and affordable, has been shown to maintain their health and reduce the risk of HIV transmission. What the revisions mean, globally, is that 3 million deaths and 3.5 million new HIV infections could be averted in the next twelve years—most in low and middle-income countries, with the largest impact expected in Africa, home to 70% of people living with HIV. WHO Director-General Dr. Margaret Chan called the revisions “another leap ahead in a trend of ever-higher goals and ever-greater achievements.”
The updated guidelines represent an important policy development and send an encouraging message reinforcing the notion of health care as a human right, and the expected impacts are great. But the immediate effect of the revisions on Hope Through Health’s potential patients in Togo will likely be unnoticeable. “Currently half of patients eligible for HAART using a CD4 count cut off of 350 cells / ml [the previous guidelines] are underserved,” observed Mukhtar A. Adeiza of Nigeria’s Ahmadu Bello University Teaching Hospital. “This is purely because of the disparity between new infections and available resources.” Many of sub-Saharan Africa’s resource-limited countries are still not able to supply enough drugs to meet even the more conservative WHO guidelines of 2010 by treating people living with CD4 counts of less than 350. This is the case in Togo, where only 50% of patients eligible for ART [under the previous guidelines] currently have access to lifesaving treatment. So when the CD4 count cutoff is raised, the eligible population expands—but the funding necessary to provide treatment for them may not.
Andrew Lopez, Hope Through Health’s program director and on-the-ground representative in Togo, weighed in. “[With these new guidelines,] theoretically we would be able to put people on treatment earlier and give them a better chance of living longer more productive lives. Now we just need the money. If we can put this into practice it will have huge impacts on treatment and prevention.” The WHO estimated that expanding treatment would add about 10% to the $23 billion annually spent on HIV treatment. But for some countries, including Togo, the money to do that simply is not there. Best, Julia Ben-Asher Communications Associate Hope Through Health