The UN has revised treatment guidelines to allow nearly 10 million more people to receive HIV drugs. The question is where to come up with an additional $2 billion a year to fund expanded treatment.
On Sunday, The World Health Organization (WHO) announced that after weighing up evidence for drug efficacy, benefits for the immune system and potential side effects, it would recommend raising the CD4 - the key immune cells targeted by HIV - threshold to 500 cells per microliter (1 milligram) of blood.
The UN agency's previous guidelines called for drug initiation when the tally of CD4 cells reached 350 cells or less per microliter (1 milligram).
"Treating people with HIV earlier ... can both keep them healthy and lowers the amount of virus in the blood, which reduces the risk of passing it to someone else," the WHO reported.
About 34 million people were reported to have HIV in 2011, 70-percent in sub-Saharan Africa. Under the current cell-count benchmark, 16.7 million became medically eligible last year to receive the drug "cocktail," which rolls back infection although it does not cure it.
Anti-retroviral treatment reached 30 times more people last year than it had a decade earlier, when only 300,000 people in low and middle-income countries received the drugs, at the time exceedingly expensive, said Gundo Weiler of the WHO's HIV/AIDS department.
"Over the last decade, the scale-up of anti-retroviral treatment in low- and middle-income countries has averted 4.2 million deaths," Weiler added.
‘Another leap ahead'
Despite years of fundraising and efforts to build medical infrastructure in poor countries, only 9.7 million of the 16.7 million eligible for treatment currently receive it.
"These guidelines represent another leap ahead in a trend of ever-higher goals and ever-greater achievements," WHO chief Margaret Chan said. "With nearly 10 million people now on antiretroviral therapy, we see that such prospects - unthinkable just a few years ago - can now fuel the momentum needed to push the HIV epidemic into irreversible decline," she added.
The guidelines will add 10-percent to the estimated $22-24 billion (17-18.5 billion euros) needed each year to fully respond to the global HIV/AIDS epidemic. That figure includes not only treatment, but also prevention and diagnostics, said Gottfried Hirnschall, head of the WHO's HIV/AIDS department. In 2011, the actual global spending stood close to $17 billion.
"It's not coming for free," Hirnschall said. "But the impact will be substantial," he added, stressing that "we are expecting 3 million additional deaths will avoided between now and 2025, and 3.5 million additional new infections averted."
UNAIDS head Michel Sidibe said costs would shrink as prices decline and countries deliver treatment more efficiently. He said "fewer deaths, less sickness" took a burden off health systems and meant patients could remain in the workforce.
Many countries "are really seeing the benefit of putting their people on treatment," Sidibe said. "If we do not pay now, we will pay later, we'll pay forever," he added.
The epidemic has killed 25 million people in 32 years. UNAIDS reported that deaths fell to 1.7 million in 2011, down from a peak of 2.3 million in 2005 and 1.8 million in 2010. Officials have also made progress in getting more patients into treatment: 9.7 million received drugs in 2012, up from 300,000 a decade earlier, according to WHO data published on Sunday.
mkg/jlw (Reuters, AFP, dpa, AP)