STRATEGIC USE’ OF HIV MEDICINES COULD HELP END TRANSMISSION OF HIV

Insincerity, poor funds administration, unclear motives of key NGO personnel leaves little to cheer in Nigeria

Alexander Chiejina

More strategic use of antiretroviral HIV medications can significantly reduce the transmission of the virus according to World Health Organization (WHO) proposals that will be presented at the XIX International AIDS Conference in Washington, DC on Sunday.

According to Margaret Chan, Director-General, WHO, “every year, more than a million more people in low- and middle- income countries start taking antiretroviral drugs “But for every person who starts treatment, another two are newly infected.”

While further scale-up and strategic use of the medicines could radically change this trend, Chan noted that there have evidences that the same medicines used to save lives and keep people healthy can also stop people from transmitting the virus, thereby reduce the chance such individuals pass it to another person.

In 2011, a large multi-country study by the HIV Prevention Trials Network showed that anti-retrovirals (ARVs) cut transmission of HIV by 96 percent within couples where one partner is HIV-positive and the other is not infected. A later study in South Africa reinforced these findings.

“When people take anti-retrovirals, the amount of HIV in their body is decreased, making them much less likely to pass the virus to others. If we can get, and keep, more people on treatment, and reduce their virus levels, we can reduce the number of new people who are infected,” revealed Gottfried Hirnschall, Director of the HIV Department at WHO. 

On the basis of this evidence, WHO advice for more strategic use of antiretrovirals include new guidelines for treating people with HIV who have uninfected partners (‘serodiscordant’ couples), recommending that antiretroviral therapy be offered to the HIV-positive partner, regardless of the strength of one’s immune system, to reduce the likelihood of HIV transmission to the uninfected partner.

Currently, up to 50 percent of HIV-positive people in on-going relationships are estimated to have HIV-negative partners. Rwanda and Zambia are already implementing this new policy with more than a dozen other countries set to join them.

Of interest is a recommendation to consider modifying current practices to prevent mother-to-child transmission of HIV (PMTCT). Malawi, for example, now offers ARVs to all HIV positive pregnant women, regardless of the strength of their immune system, and has them continue taking the medicines for life. This not only treats HIV infected women and prevents transmission to their infants, it can also protect their partners.

WHO currently recommends that people diagnosed with HIV start taking ARVs when the strength of their immune system drops to a CD4+ count of 350 cells/mm3 or lower. There is increasing evidence that HIV infection causes chronic inflammation, increasing the risk of other health problems, including certain types of cancers, heart disease and diabetes.

The Organization is now reviewing recent studies that point to the potential health benefits of giving ARVs earlier, before the immune system starts to weaken.

Providing ARVs to people living with HIV who have HIV-negative partners, pregnant women and high risk populations, regardless of their immune status, would increase the number of people eligible for treatment in low- and middle-income countries from the current figure of 15 million to 23 million.

While this will increase the cost of providing treatment in the short term, studies predict that the economic benefits of early treatment will substantially offset, and likely exceed, programme costs within 10 years of investment. This economic benefit derives from the fact that the workforce is healthier and more productive and that costs of treatment and orphan care are reduced.

In addition to more targeted treatment approaches recent studies suggest ARVs can also be used to protect people who are currently HIV-negative, but are at high risk of becoming infected.  WHO is working with a number of countries where epidemics are concentrated around communities at particularly high risk of being infected with HIV such as men who have sex with men and transgender people.

Until now, health experts believe that lack of sincerity, poor funds administration, unclear motives and lax attitude of government officials, as well as key NGO personnel have left little to cheer about, two decades after HIV/AIDS was first reported in Nigeria.

While government reports reveal that over 300,000 Nigerians die yearly of complications arising from AIDS, latest projections suggest that over 1.5 million children are said to be orphaned annually and an estimated 8 million are expected to be infected by 2012.

Official figures put the steady rise in HIV prevalence rate from 1.8 percent in 1988 to 5.8 percent in 2001, 5.0 percent in 2003 and 4.4 percent in 2005.

The 2005 survey released in 2006 estimated that there were 4,000,000 adults living with HIV/AIDS in Nigeria, and 57 percent of these are women. From the figures, there is significant variation in prevalence between states and between population groups. The epidemic is said to be fuelled in the country largely by poverty, lack of awareness, dense commercial sex networks, early age of sexual debut, poor gender empowerment, with religion and culture obstructing open debate about sexuality.

Over the next 12 months, WHO will compile a new, consolidated set of recommendations related to the use of ARVs for both HIV treatment and prevention. The document will provide countries with clinical, programmatic and operational guidance so they can make the most effective and strategic use of ARVs.

“The new guidance builds on science and experience from countries.  It will inform what ARVs to use and when to use them, how to best deliver them and how to make strategic choices that have maximum benefit for people, and maximum impact on the epidemic,” adds Hirnschall.

In addition, at the International AIDS Conference, WHO will release new guidance on a range of issues, including guidelines on HIV services for sex workers, new recommendations on using ARVs in particular circumstances for pre-exposure prophylaxis (PrEP) and the prevention of HIV and hepatitis among people who inject drugs.