When to Treat in Poor Nations?

In light of the growing evidence showing that earlier antiretroviral treatment provides the most significant health benefits for HIVers, the Los Angeles-based AIDS Healthcare Foundation, which operates HIV treatment clinics worldwide, is now calling for all HIV-positive people, even those in poor nations, to start anti-HIV drugs when CD4-cell counts drop below 350. The treatment threshold in many developing nations, where access to HIV therapy is limited, is typically when CD4 levels drop below 200 cells. 'In light of scientific evidence correlating earlier treatment with vastly improved health outcomes and lower death rates, we, the undersigned HIV/AIDS medical care providers and advocates, call on the World Health Organization and the Joint United Nations Programme on HIV/AIDS to immediately revise its current guidelines to raise the recommended treatment-initiation threshold from a CD4+ T-cell count of less than 200 cells to less than 350,' seven key AHF officials, including president Michael Weinstein and medical director Homayoon Khanlou, MD, wrote to the global health agencies. 'Raising WHO's recommended treatment-initiation threshold...would remove one more barrier to accessing lifesaving HIV/AIDS treatment and have a positive economic impact on resource-constrained countries, ultimately reducing the health care costs associated with the treatment of preventable HIV/AIDS-related conditions,' the letter states. 'Most importantly, this change could significantly improve health outcomes, increasing the odds of survival for millions of people living with HIV or AIDS in the developing world.