WHO Treatment Guidelines Updated

Prompted by clinical research into the early initiation of antiretroviral therapies for HIV performed at the GHESKIO clinic in Port-au-Prince, Haiti, the World Health Organization has revised its treatment protocols for HIVers.

Final results from the four-year study, led by Weill Cornell Medical College's infectious and tropical disease experts, were published in The New England Journal of Medicine.

The research indicates that rather than waiting until a patient's CD4+ T cells fall below the 200 cells per cubic millimeter threshold, as the previous WHO guidelines suggested, immediately initiating antiretroviral therapy greatly improved the efficacy of those medications. The study also linked early intervention with a decreased rate of incident tuberculosis, a leading cause of death among HIV patients in resource-poor countries.

"Beginning antiretroviral therapy before T-cell counts drop to 200 will save lives. In developed countries, HIV has, in recent years, become a manageable, chronic disease rather than the death sentence it was just a decade ago. These results further strengthen the assertion that the right therapies, initiated as soon as possible, can hold the virus at bay," says Warren Johnson, study coauthor and director the Center for Global Health and the B.H. Kean Professor of Tropical Medicine at Weill Cornell Medical College.

In December 2009, seven months after the researchers concluded their data gathering, the World Health Organization and the U.S. Department of Health and Human Services both updated their HIV treatment recommendations to reflect the GHESKIO conclusions: that for HIV-1-infected patients, ART is best initiated at a CD4 count of 350 or lower.

"Clinical evidence has long shown that HIV patients become vulnerable to life-threatening illness long before their CD4 count hits 200, but no one had yet definitively established that ART is effective before that crucial number," says Patrice Severe, study lead author and graduate student in the Weill Cornell Medical College Program in Clinical Epidemiology and Health Services Research. "Because antiretroviral medications are prone -- much like antibiotics -- to eliciting drug resistance in the target disease, establishing that evidence was essential. The GHESKIO study has filled that gap."