The World Health Organization is modifying its stance on the treatment for HIV. The organization now recommends that anyone who is diagnosed with HIV should be treated with antiretroviral drugs immediately.
In America this is already standard practice, but this has not always been the case. After all, isn't this intuitively obvious?
If you are diagnosed with cancer, chances are your doctor will suggest that you start chemotherapy ASAP. If you have a staph infection or strep throat, antibiotic treatment is started immediately. However, in the case of HIV, there was previously a debate about the best time to begin treatment.
As recently as 2003, there was an ongoing debate about whether HIV-infected people should be treated immediately. Some physicians were concerned about long-term side effects, as well as increasing the risk of emerging resistance, and even cost. And, there was also a question about whether treatment could be safely delayed. Some doctors believed that treating an asymptomatic patient with a properly-functioning immune systems was unnecessary.
This began to change in 2004, when the FDA approved Gilead's Truvada. Truvada, which is the drug that's being used to treat HIV-positive people in developed nations, was both effective and less toxic than previous AIDS cocktails so much so that it is approved for prophylaxis in HIV-negative people.
A recent trial of 657 gay men in San Francisco demonstrated that Truvada was so effective, that over a two-year period none of the 657 HIV-negative men contracted the virus, despite a reduction in the use of condoms.
Trials in Africa have also demonstrated that prophylactic Truvada use can substantially (sometimes entirely) reduce the transmission in serodiscordant couples (HIV+ man and HIV- woman), as well as stop the transmission of the virus from pregnant HIV+ women to their fetuses.
Given the availability of a safe and effective drug, it's now almost universally accepted that treatment should begin immediately, and the WHO's new decision reflects this.
But this change will not be easy. It means that an additional 22 million people worldwide should start HIV treatment, which will be very costly. However, proponents of the change say that it will save an estimated 21 million AIDS-related deaths and prevent an additional 21 million new cases over the next five years.
Expensive? Yes.
Worth the price? Without question.