- CD4 thresholds for starting medication regimens;
- preferred medications when building an HIV regimen;
- ways to further reduce the risk of HIV transmission from mother to child;
- and HIV treatment guidelines for taking medications while breastfeeding.
Start HIV Treatment at Higher CD4 CountsHIV treatment should be started on all people with a CD4 count less than or equal to 350 regardless of the presence or absence of symptoms. In comparison, in 2006 WHO recommended treatment when the CD4 count fell below 200. Since then data accumulated from clinical trials and clinical research have shown that starting HIV medications earlier, when CD4 counts are higher, reduces illness and progression of HIV to AIDS.
Phase Out Older MedicationsThe WHO HIV treatment guidelines recommended phasing out the use of older HIV medications that have been found to have long term side effects. Medications such as Zerit (stavudine) are to be phased out of initial regimens because of toxic side effects like lactic acidosis. In developing nations where medications are hard to come by, Zidovudine (AZT) and Viread (tenofovir) are more affordable recommendations to replace Zerit. Keep in mind that while their toxic profile may be less, they are not without risk; for example Viread has been linked to toxic kidney side effects in some people. In the Western World, it is recommended that the newest medications be used because of their low side effect profiles.
Use CD4 Testing and Viral Load MonitoringWHO recommends that CD4 testing be made more readily available in order to identify those people needing HIV treatment. They also recommend viral load monitoring where available. Keep in mind that treatment should never be denied in the event these laboratory tests are not available.
HIV Medications Earlier in PregnancyBack in 2006, WHO recommended the use of HIV medications starting about the 28th. week of pregnancy. The new recommendations are to start HIV medications at week 14 of pregnancy.
Infant Feeding when Mother is HIV PositiveIn some parts of the world, infant feeding options are very limited. The WHO recognizes this and recommends:
- Infants be fed formula which provides them the highest chance of being HIV free.
- If commercial formula and/or clean water is not available, breast feeding should continue until the infant is 12 months old providing the mother is taking HIV medications during the first year of the baby's life.
The United States has its own HIV treatment guidelines that do mimic some aspects of the WHO guidelines. Page 2 of this feature will review the US HIV treatment guidelines.