HIV-positive people must start earlier treatment: CDC

By Alison Hsiao  /  Staff reporter

Tue, Sep 10, 2013 - Page 3

Revisions have been made to the latest version of guidelines for diagnosis and treatment of HIV/AIDS, with the Centers for Disease Control (CDC) recommending earlier treatment.

People with HIV-negative sexual partners are advised to begin treatment regardless of their cluster of differentiation 4 (CD4) count.

The fourth version of the Ministry of Health and Welfare guidelines recommends an earlier starting point for HIV treatment for HIV-positive people at a CD4 T-cell count of 500 or less, or 500 T-cells or less per cubic millimeter of blood, according to the Taiwan AIDS Society.

Studies have shown that starting the antiretroviral therapy at a CD4 count of between 350 and 500 reduces the incidence of opportunistic infections and lowers the death rate in HIV-positive patients, the society said, adding that the WHO raised the treatment bar in June from a CD4 count of 350 to 500, and 90 percent of the countries in the world have since adopted the new guideline.

Another revision to the guidelines recommends that HIV treatment be provided to HIV-positive people who might transmit the virus to their sexual partners, regardless of CD4 count.

According to the result of a clinical trial — known as HPTN 052 — where one partner is HIV-positive and the other is not (serodiscordant), the antiretroviral treatment on HIV-positive people can reduce the risk of transmitting the virus to their HIV-negative sexual partners by 96 percent.

The US Department of Health and Human Services guidelines last year recommended all serodiscordant couples to start treatment regardless of CD4 T-cell counts, followed by the WHO this year.

Centers for Disease Control Director-General Chang Feng-yee (張峰義) said that the cost of HIV treatment, which has exceeded NT$2.6 billion (US$87 million) a year in recent years, is shouldered by the CDC.

Following the guidelines recommended by the WHO can lower the risk of opportunistic infections and prolong the lives of HIV-positive patients, but the price is an upsurge in the cost of medicine, Chang said.

Chang added that preliminary thoughts on how to contain the cost is to have those who often stop the treatment to discontinue taking the drugs, for now, to avoid potential drug-resistance.