‘New HIV guidelines could hamper ART rollout’

Paidamoyo Chipunza and David Shumba Health Reporters
Finding patients with a higher CD4 count of 500 in line with new global recommendations for earlier HIV treatment could hamper full implementation of the guidelines, a senior health official has said.
In an interview last week, National Aids Council (NAC) operations director Mr Raymond Yekeye said while the new guidelines were an aggressive step forward, they represented a compromise as it was difficult to get HIV positive people with a CD4 count of about 500 with no signs of Aids to get tested.

HIV testing is prerequisite for antiretroviral therapy (ART).
“Finding the patients with a higher CD4 count of 500 given the fact that they are still well could lower the number of people who know their HIV status for them to benefit from the ART programme,” said Mr Yekeye.

He said low coverage of viral load machines could also impact negatively on implementation of World Health Organisation (WHO) guidelines.
The new guidelines recommend that drugs be initiated as soon as a patient’s CD4 count falls below 500 cells per cubic millimetre of blood.

CD4s are the white blood cells that the virus first attack.
The count is an index for how much of the immune system has been destroyed, 500 is the bottom of the normal range while a patient below 200 is at high risk of fatal infections.

The previous cut off point, recommended in 2010, was a count of 350, a decade ago. When donors first began buying drugs, it was 200.
Mr Yekeye said there are only four viral load testing machines currently stationed at central hospitals in Harare and Bulawayo.

According to the guidelines, countries should move from using CD4 count to viral load testing in determining eligibility for ARVs.
Viral load testing confirms the level of HIV in a person’s blood while CD4 Count measures the body’s defence system to the virus.

Mr Yekeye lamented the slow uptake of paediatric antiretroviral drugs, which he attributed to the low number of children being tested.
The WHO guidelines also stipulate that all HIV positive children under the age of five years should be commenced on ARVs despite their CD4 count testing. Mr Yekeye said the country has secured enough funding for the period up to 2015.

“Currently, we have enough funding up to 2015 but we continue to mobilise resources to cater for the period after 2015,” he said.
He said 70 percent of the current funding for HIV was availed by the donor community while local resources accounted for 30 percent.

He said since adoption of the WHO guidelines, the number of people on ARVs continue to increase.
There are currently 700 000 people on treatment out of the 1 207 175 people estimated to be living with HIV.

Zimbabwe adopted the new guidelines towards the end of last year and is in the process of scaling up interventions as recommended by the health body. Other guidelines compel all HIV positive pregnant women and HIV breastfeeding women to receive ARVs regardless of their CD4 count.

Couples with one partner positive (discordant) should also be commenced on treatment.