HIV is now 'chronic manageable disease'

The universal killer HIV has been transformed into a chronic manageable disease, according to a specialist who compared the stigmatised disease to diabetes.

"The life expectancy of people with HIV is almost normal and the great majority of patients in Malta receiving treatment are doing very well," infectious diseases specialist Charles Mallia Azzopardi said.

His comments coincide with the ongoing AIDS conference in Vienna this week where the UN's World Health Organisation released HIV guidelines.

The recommendations highlight the need to start treating HIV with antiretroviral therapy at an earlier stage of infection than practised previously.

In Malta, British guidelines are followed which had already recommended treating patients with antiretrovirals at this early stage. Dr Mallia Azzopardi said starting this treatment at such an early stage was a practice Malta had followed for at least two years.

In 2006, WHO advised antiretroviral therapy initiation when the blood cells hijacked by HIV, known as CD4 cells, were lower (200 cells or less per microlitre of blood) but last year it raised the figure (to 350 CD4 per microlitre) thus starting treatment at an earlier stage of infection. The report issued this week amplified this recommendation.

Earlier treatment can prevent opportunistic infections by viruses which catch an easy ride because of an HIV patient's poor functioning immune system. These include infections like tuberculosis (TB), the number one killer of people with HIV. Deaths from TB can be reduced by as much as 90 per cent if people with both HIV and TB start treatment earlier.

In addition to saving lives, earlier treatment also has prevention benefits. As it reduces the level of the virus in the body, it means HIV-positive people are less likely to pass the virus on to their partners.

These new guidelines are predicted to have a large impact on both patients and health budgets. Earlier initiation means patients will be exposed to therapy for longer; one or two years according to the report. They will therefore also be exposed to its side effects and resistance.

Dr Mallia Azzopardi stressed the need for patients to continue medication once started as discontinuation will lead to resistance and tamper their chances of responding to treatment if this is restarted. The famous antiretroviral therapy drug "cocktail" has been central in this large step of HIV treatability and its leading role has been emphasised in the new report. It can reduce viral levels, known as viral load, to below detectable levels, although it does not eliminate the virus completely.

Sadly though, it has many side effects, ranging from headaches and lethargy, to hair loss and nausea, which are central to patient's noncompliance to treatment.

Antiretroviral therapy was first introduced in 1996 but was first restricted to rich countries due to its then high cost. Although this has improved, at least 4.3 million badly-infected poor people still do not have access to treatment.