South Africa will adopt the World Health Organisation’s new “test and treat” guidelines for HIV patients in September, enabling people to start treatment as soon as they are diagnosed instead of having to wait until their immune systems weaken, Health Minister Aaron Motsoaledi has announced.
Business Day reports that current guidelines say patients should wait until their CD4 count, which measures the strength of the immune system, falls below 500 cells per mm³ and that pregnant HIV-positive women should start lifelong treatment.
The report says the government also plans to start providing sex workers with preventative treatment, known as pre-exposure prophylaxis, in June, said the minister.
While at first sight the WHO’s guidelines might suggest that the country is destined to double the number of patients taking antiretrovirals, government officials and independent experts have previously been quoted as saying that a massive surge in demand is unlikely. Previous policy changes have not triggered large spikes in the numbers of those receiving treatment, and the numbers on treatment are expected to continue to rise steadily.
“These new programmes will cost an additional R1bn in this year’s budget, and we are happy the Treasury has made this amount available, despite the harsh economic environment in which we find ourselves,” Motsoaledi is quoted in the report as saying.
South Africa has the world’s biggest HIV epidemic, and the world’s biggest treatment programme. Motsoaledi said Aids deaths in SA had declined from 320,000 a year in 2010 to 140,000 a year in 2014, thanks to the government’s drive to expand its treatment programme.
The DA’s shadow minister for health Wilmot James paid tribute to the minister’s commitment to tackling the HIV/Aids epidemic, saying “we all applaud you”.
Professor Salim Karim‚ director of Aids research centre Caprisa‚ said “the minister’s announcement is undoubtedly a step in the right direction”. The Times reports he continued: “This policy change has been expected and follows hard on the heels of the December World Health Organisation guidelines on antiretroviral treatment. The impetus for this policy change emanates from compelling new evidence from the START trial presented at the Vancouver Aids conference last year.”
A 2011 trial conducted in 35 countries called the Strategic Timing Anti Retroviral Treatment (START) study had 4‚685 HIV positive participants‚ half who started HIV treatment as soon as they were diagnosed. The other group waited until their CD4 count dropped below 350.
The report says the group that started treatment later had double the incidence of TB‚ non Hodgkins Lymphoma‚ Karposi Sarcoma (a skin cancer) and non-HIV related disease such as heart attacks and certain cancers – 86 versus 41 in the group who had treatment immediately. The evidence that starting treatment early was so compelling that the trial was stopped early as it became unethical to delay treatment to those not receiving it.
“We now have clear-cut proof that it is of significantly greater health benefit to an HIV-infected person to start antiretroviral therapy sooner rather than later‚” said Anthony S Fauci‚ director of the US National Institute of Allergy and Infectious Disease‚ at the time. He added: “Moreover‚ early therapy conveys a double benefit‚ not only improving the health of individuals but at the same time‚ by lowering their viral load‚ reducing the risk they will transmit HIV to others. These findings have global implications for the treatment of HIV.”