Start HIV drug therapy earlier, says World Health Organization

The World Health Organization recommends beginning antiretroviral drug therapy for HIV when the immune system is still healthy.
(Allen J. Schaben / Los Angeles Times)

The World Health Organization has a new philosophy regarding antiretroviral treatment for people with HIV: Why wait?

If a person has a healthy immune system, they have at least 500 CD4 cells per cubic millimeter of blood. But those CD4 cells, white blood cells that signal the immune system to fight off unwanted guests, are targeted and destroyed by HIV.

Until now, the WHO had recommended that patients with HIV wait to start treatment only after their immune systems had sustained some damage from the virus and their CD4 cell count had fallen below 350 cells/mm3.

After examining abundant data on the effect of starting treatment earlier, WHO officials said they felt confident that earlier treatment could lower the amount of virus in the blood and reduce the risk of transmission.


“This is a landmark recommendation that will increase universal access for HIV treatment around the world,” said Dr. Jeffrey Klausner, an infectious disease specialist at UCLA’s Geffen School of Medicine.

Currently, there are 9.7 million people taking ART therapy, according to Dr. Margaret Chan, the WHO’s director-general. By changing the threshold from 350 to 500, the number of people eligible for ART will rise to 26 million, the WHO said. That’s more than three-quarters of all people infected with HIV.

“With nearly 10 million people now on antiretroviral therapy, we see that such prospects — unthinkable just a few years ago — can now fuel the momentum needed to push the HIV epidemic into irreversible decline,” said Chan in a statement.

The frontline treatment for HIV is a cocktail of three ART medications. In another of its recommendations, the WHO said those drugs should be taken in a single pill, once a day.

The one-stop, once-a-day approach makes everything easier and more cost-effective, Klausner said.

“It’s simpler for the manufacturers to combine ingredients into one pill, it’s simpler for countries to move boxes of single pills around the country, and it’s simpler for patients to take one pill, once a day,” he said.

Every recommendation carries both risks and benefits, but in this case, the benefits outweigh the risks, according to Klausner.

“The overwhelming evidence from a public health perspective is that starting medications earlier is associated with improved outcomes for the health of the population,” he said. Recent research from the United States and Europe indicates that with proper ART, HIV patients can have similar life expectancy to non-infected people, he added.


The WHO also recommended that all HIV patients under 5 years old, who are pregnant or breast-feeding, and who also have tuberculosis begin ART immediately, regardless of their CD4 cell count.

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