The number of HIV-infected South Africans on antiretroviral drugs (ARVs) will more than double – from 3.1-million to 6.4-million – if the health department is to implement new World Health Organisation (WHO) guidelines, which was announced yesterday. 

The guidelines recommend that everyone infected with HIV, regardless of their CD4 counts are put on ARVs. A CD4 count is a measurement of the strength of someone’s immune system.
South Africa currently only offers South Africans with a CD4 count of below 500 cells/mm3 ARVs, although HIV-infected pregnant women and children under the age of five receive life-long medication, irrespective of their CD4 count.

The president of the Southern African HIV Clinicians Society, Francesca Conradie, said “this move is based on evidence that shows that this has a significant impact on the overall health of people with HIV, and is part of a robust effort to significantly reduce the number of people dying from HIV-related causes”.

According to the health department’s deputy director for HIV, Yogan Pillay, his department will convene an “expert meeting” to discuss the guidelines within the next two to three weeks. “We welcome the guidelines and agree with the science behind it. The key issue is now to discuss the operational issues such as cost and implementation,” he said.  

Pillay said Health Minister Aaron Motsoaledi will announce his decision about when and how to implement the new guidelines before the end of March 2016, but “hopefully even before the end of 2015”. 

According to Pillay, the 3.1-million people on ARVs in the public health sector are covered at a cost of R4 000 per patient per year. Each year, an additional 600 000 more people go on treatment. “From experience we know that the uptake of ARVs by HIV-infected people with high CD4 counts is quite slow, as they generally don’t feel sick,” Pillay said. “We therefore don’t expect that everyone with HIV will take up ARVs immediately once we’ve announced the uptake of the new guidelines. A goal of 90% of HIV-infected people would be more realistic and so would a phased-in approach.”  

The new guidelines recommend that specific combinations of ARVs are given to anyone who is at high risk of contracting HIV. Several studies have shown that when HIV negative people take these combinations of ARVs, they drastically reduce their chances of contracting the virus.  

Conradie has welcomed “the addition of pre-exposure prophylaxis [preventative treatment] to those who are at substantial risk of HIV”. But she warned that the ARVs, TDF and FTC, that are used for preventative treatment, are not yet registered for this purpose in South Africa. “We would urge the regulatory authorities to expedite the registration,” she said. Pillay, however, said the registration should be through by November.

“We would start with the most vulnerable groups in South Africa – female sex workers, men who have sex with men, discordant couples [couples where one person is HIV positive and the other HIV negative] and young women between the ages of 15 and 24,” Pillay said. “That’s what the WHO recommends.”