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WHO revises HIV guidelines

The World Health Organisation (WHO) has announced changes to its prevention and treatment guidelines for HIV

World AIDS Day ribbonThe World Health Organisation (WHO) has announced changes to its prevention and treatment guidelines for HIV. It has advised earlier use of antiretroviral therapy and the 'phasing' out of stavudine as a treatment because of long-term irreversible side-effects.

In the guidelines, WHO recommended that treatment should commence when patients' levels of CD4 cells reach 350, compared with earlier advice that it commence at 200. The agency said: "an earlier start to antiretroviral treatment boosts the immune system and reduces the risks of HIV-related death and disease," and also lowers transmission of HIV.

In addition, the agency is now encouraging HIV-positive women and their babies to take antiretrovirals while breastfeeding to prevent mother-to-child transmission of the virus that causes AIDS.

Countries have been told to "phase out the use of stavudine because of its long-term, irreversible side-effects," including wasting and a nerve disorder leading to numbness and burning pain in the hands and feet. Instead they are advised to use "less toxic" but "equally effective" alternatives zidovudine or tenofovir. 

Stavudine, also known as d4T, is marketed as Zerit by US drugmaker Bristol-Myers Squibb. Generic versions are made by India's Cipla, Aurobindo Pharma and Strides Arcolab.

Zidovudine was first manufactured by GlaxoSmithKline (GSK) whose patent expired in 2005, Aurobindo and Ranbaxy Laboratories make a generic version. Tenofovir is marketed by Gilead Sciences as Viread.

According to Siobhan Crowley of the WHO's HIV/AIDS Department, of the four million people who take antiretroviral therapies globally, about half are currently on a regimen containing stavudine. This is down from 80 per cent in 2006 when WHO first expressed concern about its long-term effects.

An estimated 33.4 million people worldwide, two thirds of them in sub-Saharan Africa, are infected with the AIDS virus. The advice could double the number of people worldwide who qualify for treatment, adding an extra three to five million patients to the five million already awaiting AIDS drugs.

Some experts have noted that the new advice may significantly increase the cost of global AIDS programmes and it raises questions about how developing countries and donor agencies will pay for the lifelong AIDS treatment, when many programmes in Africa are already struggling.

World Aids Day ribbon

December 1, 2009 is World Aids Day 

1st December 2009

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