Gov't fine tunes treatment programme

The Zambian government has begun treating people living with HIV earlier, a move intended to reduce deaths and medical complications resulting from the disease.

According to national antiretroviral (ARV) treatment coordinator Dr Albert Mwango, the state was now making ARVs available when people had reached a CD4 count [which indicates the strength of the immune system] of 350, dropping earlier guidelines that recommended a CD4 count of 200.

Deciding on when to start a patient on ARV drugs is usually based on a combination of CD4 cell count test results and HIV disease progression, which the World Health Organisation (WHO) has defined according to four clinical stages, with stage four being AIDS.

"We decided to move away from the ... protocols based on the lessons learnt in the field that showed that clients who start when their immunity is low had a lower recovery rate," Mwango told IRIN/PlusNews.

Mwango said research has shown that people who start treatment early respond better to the medication and are less likely to develop AIDS-related illnesses. This has led the United States, the United Kingdom and a number of countries in Africa to change their treatment guidelines.

The WHO revised its guidelines in 2003 to recommend that a patient who has reached stage three of the disease and has a CD4 count of less than 350 should begin treatment.

"The new eligibility criteria include pregnant women found to HIV positive. This means that once an expectant mother is found to be positive and her CD4 count is 350 or below, she needs to commence treatment," Mwango noted.

The move is one of the latest measures introduced under the revised treatment protocol. Another change is the introduction of a new treatment regimen for all new patients enrolled after September 2007.

"The advantage of the new regimen is that clients take it once daily and it has few side effects," Dr Mwango said.

Dr Marimba Chiko, a medical superintendent in the Lusaka district, told IRIN/PlusNews that the guidelines were now slowly being implemented.

"We have not enrolled as many people as we would want on the new regimen due to insufficient supply of one of the three drugs - Truvada. We however have been informed that the stocks are now in and we are hopeful that we will enrol more," Chiko said.

Mwango said 156,753 people were on ART by December 2007. These include clients from public, private, military and mission hospitals across the country. Zambia has an estimated adult HIV infection rate of 14 percent.

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