Govt needs to treat HIV+ people sooner, urges expert
JOHANNESBURG ‘HIV positive South Africans need access to antiretroviral (ARV) treatment sooner than stipulated by government in order to save more lives and money.
This is according to research conducted by Professor Robin Wood of the University of Cape Town’s Desmond Tutu HIV Research Centre.
At present, people with a CD4 count (measure of immunity in the blood) of 200 or less are eligible for ARV drugs at government clinics.
But, says Wood, ‘we are treating our patients too late.’
‘Starting a patient on treatment when their CD4 count is below 200 gives you a quick bang for your buck as there is a rapid short term improvement,’ he told the first Priorities in AIDS Care and Treatment (PACT) conference in Johannesburg this week.
‘But if you look three years down the line, the outcome is much better for those patients whose counts were above 200.’
He said that placing patients on ARVtreatment when their CD4 cell counts are between 200 and 350 not only improved mortality, but was also cost effective.
According to calculations by Wood’s, life expectancy for an HIV positive person in the absence of antiretrovirals is around 6,3 years.
This goes up to an average of 17 years if a person with a CD4 count of less than 200 starts ARV treatment.
But starting the patient with a CD4 count of between 200 and 350 increases life expectancy by a further six years, extending life expectancy to 23 years.
‘We need to diagnose and start patients earlier,’ he urged, adding that ‘waiting lists are also proving to be fatal’.
Somerset Hospital, Wood’s teaching hospital in the Western Cape, has a waiting list of about four months.
Nine clinics forming part of the HIV Centre’s anti-retroviral programme in Cape Town recorded a death rate of only 7,8% after 12 months of therapy, an impressive statistic by international standards. The death rate was measured within the first 12 months of placing the patients on anti-retroviral therapy.
However, when Wood measured the death rates from the time of referral (from the clinic to the ARV site) the picture changed dramatically. It was found that 28% of patients died from the time of referral until the time they are placed on treatment.
Many patients had died of wasting syndrome, a condition for which there is no specific treatment, while others died of tuberculosis, Kaposi’s sarcoma and cryptococcosis.
He reiterated the critical need to find and treat patients early, and said the tuberculosis programme was a good place to start as 60% of patients entering the ARV programme had had TB in the past.
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