Lakhs of HIV deaths can be averted as India follows WHO’s recommendations
Two years after the
World Health Organisation (WHO) recommended that antiretroviral
therapy (ART) be
initiated in people living with HIV irrespective of the CD4 (a type of
white-blood cell) counts,
India has aligned its policy with the guideline. In a major shift,
Union Health Minister
J.P. Nadda had recently said that any person who tests positive for
HIV will be provided
ART “as soon as possible and irrespective of the CD count or clinical
stage”. Nearly 4.5
lakh deaths can be averted through this move.
It was in 2002 that
the WHO first issued its ART guidelines. In the absence of AIDS-defining
illnesses, the WHO
set CD4 count less than 200 cells per cubic millimetre as the threshold to
begin ART treatment.
Over time, it changed its guidelines and, in 2013
increased the
threshold to CD4 count less than 500 cells per cu. mm.
Change in WHO
guidelines
The recommendation
was based on the evidence that an earlier initiation of ART will help
people with HIV live
longer, remain healthier and “substantially reduce” the risk of them
transmitting the
virus to others. The availability of safer, affordable and easy-to-manage
medicines that could
help to lower the amount of virus in the blood played a key role in the
WHO’s decision.
Earlier initiation could avert an “additional three million deaths and prevent
3.5 million more new
HIV infections between 2013 and 2025,” noted the WHO in 2013.
In 2015, the WHO once
again changed its guidelines. Based on evidence from clinical trials
and observational
studies since 2013, it became clear that an earlier use of ART, irrespective
of the CD4 count,
results in better clinical outcomes. Accordingly, it recommended that ART
be initiated in
HIV-positive people at any CD4 cell count.
As per 2015
estimates, India has 2.1 million HIV-positive people, of which only 1.6 million
have been diagnosed
and about a million are on treatment. But over half a million people are
not even aware of
their HIV status.
With the government
changing its treatment guidelines, the 0.6 million who have been
diagnosed but not
been on treatment are now eligible for treatment. Of the 0.6 million, about
0.25 million have
been enrolled for pre-ART care and can be started on treatment almost
immediately. But the
biggest challenge will be to identify the 0.35 million who have been
diagnosed but not on
treatment and the 0.5 million who have been infected but have not been
diagnosed. Also,
nearly 80,000 people get infected each year.
Even as efforts are
on to expand the 1,600 treatment delivery sites that are currently
operational, there
should be greater focus now on identifying people with HIV. The
government has plans
to start community-based testing to bring it closer to those in need, and
target special groups
that are more vulnerable to infection such as partners of people who are
HIV-positive.
Source: The
Hindu
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