WHO: Early treatment of those with HIV would help stop spread

LONDON -- Young children and certain other people with the AIDS virus should be started on medicines as soon as they are diagnosed, the World Health Organization said in new guidelines that also recommend earlier treatment for adults.

The advice will have the most impact in Africa, where nearly 70 percent of people with HIV live. Many rich countries already advocate early treatment. WHO's guidelines were released Sunday at the International AIDS Society meeting in Kuala Lumpur, Malaysia.

About 34 million people worldwide have HIV, the virus that causes AIDS. HIV attacks key infection-fighting cells of the immune system known as T-cells. When the count drops to 200, people are considered to have AIDS. In the past, WHO recommended countries start treating people with HIV when their T-cell count fell to 350; a normal count is between 500 and 1,600.

The recommendations say to treat earlier, when the T-cell count hits 500.

In addition to children younger than 5, WHO says several other groups also should receive AIDS drugs as soon as they're diagnosed with HIV: pregnant and breast-feeding women, people whose partners are uninfected and those who also have tuberculosis or hepatitis B.

The guidelines mean an additional 9 million people in developing countries now will be eligible for treatment. Only about 60 percent of people who need the lifesaving drugs receive them.

"WHO has recognized that time is the most important commodity when it comes to battling the HIV epidemic," said Sharonann Lynch, HIV policy adviser at Doctors Without Borders, which contributed to the guidelines.

She said while costs for rolling out this treatment might be expensive, the strategy ultimately would result in fewer HIV infections and deaths.

The guidelines mean the total global spending on AIDS -- about $23 billion a year -- would rise by about 10 percent, according to Gottfried Hirnschall, director of WHO's HIV department. It's unclear how willing donors will be to pitch in for more AIDS treatments.

Hirnschall said the cheapest course of the drugs costs $127 per person every year under programs that have negotiated prices for poor countries, but the price can be much higher elsewhere.

In the U.S., officials recommend everyone who has HIV be on treatment but say there is only "moderate" evidence for starting therapy when the immune system still is working normally.

WHO's new guidelines are based on recent studies suggesting people with HIV who start treatment before their immune systems weaken live longer. The case of a U.S. baby girl with HIV who was treated aggressively within 30 hours of birth suggests very early treatment could prevent the virus from ever getting a foothold. Earlier this year, doctors announced the girl apparently was cured after stopping medication for about a year with no signs of infection.

Several studies also have hinted that starting therapy early dramatically cuts the chances an infected person will pass the virus to a sexual partner.

If all countries start treating people with HIV in line with the new recommendations, WHO estimates 3 million lives could be saved and 3.5 million new infections could be avoided in the next decade.

Convincing people to take a lifelong regimen of drugs that come with side effects including liver problems and severe skin reactions, will be challenging.

"These drugs are not like sweeties," said Dr. Sarah Fidler, an HIV expert at Imperial College London who is leading a trial in Africa studying issues including the effectiveness of immediate treatment for people with HIV. She had no role in the WHO guidelines.

Studies in Africa have shown varying compliance rates from 50 percent to more than 90 percent, similar to elsewhere in the world. Patients not taking their medicines at least 70 percent of the time, also could lead to drug resistance.

Fidler said while the WHO guidelines are a step in the right direction, implementing them would not be easy.

"For people struggling with other issues like poverty, taking pills for a disease that isn't making them sick yet might not seem like the most important thing in the world," she said. "This is not going to be as simple as just giving drugs to everybody."