(Reuters) - An
international health panel has recommended for the first time that all HIV
patients be treated with antiretroviral drugs, even when the virus's impact
on their immune system is shown to be small.
The nonprofit International Antiviral Society-USA cited
new evidence that untreated infection with the human immunodeficiency virus
that causes AIDS can also lead to a range of other conditions, including
cardiovascular disease and kidney disease. In addition, data have shown that
suppressing HIV reduces the risk of an infected person passing the virus to
"We are no longer only focused on traditional
AIDS-defining infections. We know that HIV is doing damage to the body all
the time when it is not controlled," said Dr. Melanie Thompson, principal
investigator of the AIDS Research Consortium of Atlanta and a member of the
Antiviral Society panel.
The recommendations are global, but mainly aimed at
"resource-rich" countries who can cover the cost of the medications, she
said. The guidelines were published in the Journal of the American Medical
Association at the start of the International AIDS Society's 2012
conference, which runs from Sunday through Friday in Washington, DC.
In addition to studies showing that treatment with
antiretroviral drugs reduces the risk of HIV transmission, trials have shown
a protective effect when the drugs are used by at-risk people who are not
already infected with the virus.
U.S. health regulators earlier this month approved use of
Gilead Sciences' Truvada for HIV-negative adults who are at risk of
acquiring the virus. Like other antiretroviral drugs, the Gilead pill is
designed to keep the virus that causes AIDS in check by suppressing viral
replication in the blood.
"The drugs are convenient, have very little side effects
and their benefits are becoming clearer and clearer -- both for the infected
person and from a public health standpoint," said Dr. Paul Volberding,
director of the Center for AIDS Research at the University of California,
San Francisco and another member of the panel.
CHECKING WHITE BLOOD CELL LEVELS
The guidelines echo those issued in March by the U.S.
Department of Health and Human Services, which also cited improved drugs and
new studies showing patients benefit from treatment regardless of their
level of infection-fighting white blood cells.
Previous recommendations called for antiretroviral drugs
to be started for only patients whose CD4 cell counts had fallen below 500
per cubic millimeter of blood.
A normal CD4 count in a healthy adult varies between 500
and 1,200, according to HHS.
Earlier guidelines were based largely on the potential for
health complications associated with initial antiretrovirals as well as
concerns that patients without symptoms might not adhere to the therapy.
"The risk/benefit of the kinds of therapies we had
available led us to be more restrictive in terms of when to start
treatment," Dr. Thompson said.
The availability of new multidrug combination pills has
made it easier for patients to take them consistently and has lessened the
risk of drug resistance, she said.
"We were really focusing on the treatment aspect of it and
didn't have the prevention data, which we now have," Dr. Volberding said.
The United Nations estimates that around 34 million people
are living with HIV, including more than 1.2 million Americans.
The World Health Organization recommends that people
diagnosed with HIV start taking antiretroviral therapy when their CD4 cell
count hits 350 or less. It said this week that it is reviewing recent
studies pointing to the potential benefits of giving the drugs earlier,
before the immune system starts to weaken.
(Reporting By Deena Beasley; Editing by Michele Gershberg
and M.D. Golan)