Physicians in developed countries have been treating their HIV-infected patients with highly active antiretroviral therapy (HAART) for many years and have witnessed the dramatic benefits of early initiation of treatment: patients are healthier, return to normal livelihoods, have fewer opportunistic infections, fewer clinic visits, fewer hospitalizations and are living longer.
Both the United States Health and Human Services (HHS) and the International AIDS Society (IAS) have declared that the standard of care for HIV-infected individuals is to “treat all” HIV infected individuals regardless of the clinical status or CD4 count. Together these organizations represent over 16,000 scientists and clinicians, healthcare workers and advocates.
Why are these announcements essential for controlling the HIV epidemic? First it is necessary to clearly articulate to the World Health Organization that clinical data conclusively demonstrates that early initiation of HAART provides the greatest benefit for HIV-infected men, women and children and should be the standard of care. Second, if indeed treatment recommendations are evidence based as WHO claims, then evidence accepted by the overwhelming majority of international HIV specialist must also be accepted by WHO when developing their international treatment recommendations that impact millions of lives.
If WHO is to maintain its international scientific and ethical credibility as a guardian of world health they must immediately revise their HIV treatment guidelines to be compatible with HHS and IAS. WHO cannot employ truncated economic analyses to delay updating their treatment recommendations. Their economic considerations focus on the cost of drugs. But the cost of HAART has now reached unprecedented low levels. Economic arguments which focus solely on the cost of drugs provide an unrealistic long-term analysis of costs to control the epidemic, reach false conclusions related to treatment and human costs of the epidemic, and slow progress in controlling the spread of HIV. The reduced number of hospitalizations, opportunistic infections including tuberculosis, return of individuals to productive lives, increased survival of parents to care for children preventing orphan hood are all factors which point to long-term economic benefits. In addition, the now well-established decrease in HIV transmission associated with early and continuous HAART suggests that this is an essential and economically justifiable component of HIV prevention.
“TREAT ALL” (see previous post here) is ethically sound and the correct scientific, medical, economic, and public health approach to controlling the HIV epidemic.