Experts say HIV treatment ought to start sooner

People with HIV need to start antiretroviral treatment sooner, according to South African and international specialists gathered for a major Aids conference in Cape Town this week.

Dr Pedro Cahn, a past president of the International Aids Society, which is meeting in Cape Town, said: “Everyone agrees that a CD4 of 350 should be the minimum standard.”

CD4 tests measure immune strength; in South Africa, the policy is that patients are offered Aids drugs in the public health system when their CD4 count drops to 200 and below, or they develop complications.

In fact, most patients start therapy with far lower CD4 counts, said Dr Francois Venter, president of the HIV Clinicians Society of Southern Africa, as they tend to seek medical help only when they fall sick, and not as the result of regular testing.

If patients with CD4s of 350 were offered treatment, the number of people needing the drugs would soar. In the past seven years, about four million people worldwide (about 600000 of them in South Africa) have been put on antiretrovirals, and about six million more need treatment at the CD4 threshold of 200.

One model showed earlier treatment would save lives and be more cost-effective by preventing opportunistic infections and reducing the burden on health systems.

Dr Wafaa El-Sadr, director of the International Centre for Aids Care and Treatment Programmes in the US, said the world had seen a dramatic decline in Aids deaths since 1996 — but now non-Aids -related mortality was increasing.

She said that people with HIV were at higher risk of dying from non-Aids related diseases as they aged, like stroke or renal failure, than those without the virus. El-Sadr said studies had shown that deferring treatment increased the risk of death.

Another urgent message from the conference was to replace the drug Stavudine (d4T), used in most first-line antiretroviral programmes, including in South Africa. It has side effects such as toxicity and lipoatrophy — the localised loss of fat tissue.

“This conference should be the one to say thank you very much d4T, goodbye and never come back again,” said Cahn.