GENEVA, 30 November 2009 – On the eve of World AIDS Day (1. December), the World Health Organization (WHO) Monday warned countries to phase out the use of Stavudine, the most widespread antiretroviral drug, because of long-term, irreversible side-effects in HIV patients including wasting and a nerve disorder.
Stavudine, or d4T, is still widely used in first-line therapy in developing countries due to its low cost and widespread availability. Zidovudine (AZT) or Tenofovir (TDF) are recommended as less toxic and equally effective alternatives.
United Nations Monday, too, issued new recommendations for fighting the pandemic, calling for an earlier start to treatment for adults and adolescents, as well as urging HIV-positive mothers and their infants to take antiretroviral drugs (ARVs) while breastfeeding to prevent transmission.
But the main challenge lies in increasing treatment in resource-limited countries, where expansion of antiretroviral therapy (ART) is hindered by weak infrastructure, limited human and financial resources, and poor integration of HIV-specific care within broader maternal and child health services.
An estimated 33,4 million people are living with HIV/AIDS, and there are some 2,7 million new infections each year. Globally, HIV/AIDS is the leading cause of mortality among women of reproductive age.
In 2006, WHO recommended that all patients start ART when their CD4 count (a measure of immune system strength) fell to 200 cells/mm3 or lower, at which point they typically show symptoms of HIV.
But with trials showing that starting ART earlier reduces rates of death and disease, WHO now recommends a higher threshold of 350 cells/mm3 for starting ART for all HIV-positive patients, including pregnant women, regardless of symptoms.
The new recommendations for women and infants contrast with the guidelines of 2006, when WHO called for ARVs to be provided to HIV-positive pregnant women in the third trimester (starting at 28 weeks) to prevent mother-to-child transmission. Now, after trials, it urges starting ARVs at 14 weeks of pregnancy and continuing through the end of breastfeeding, which should last 12 months, thus reducing the risk of transmission.
– In the new recommendations, we are sending a clear message that breastfeeding is a good option for every baby, even those with HIV-positive mothers, when they have access to ARVs, WHO’s Assistant Director General for Family and Community Health. Daisy Mafu said.
WHO noted that the recommendations will result in a greater number of people needing treatment, but said the associated costs of earlier treatment might be offset by decreased hospital costs, increased productivity due to fewer sick days, fewer children orphaned by AIDS and a drop in HIV infections.
Kilde: FNs Nyhedstjeneste
