On World AIDS Day, New WHO Recommendations for Use of Antiretrovirals Represent a Step Forward to a Generation Free of HIV
December 1, 2009
Statement of Nicholas Hellmann, M.D., Executive Vice President of Medical and Scientific Affairs
The Elizabeth Glaser Pediatric AIDS Foundation
– In time for World AIDS Day, which this year highlights universal access to HIV services and human rights, the WHO has issued new, welcome recommendations on the use of antiretroviral drugs (ARVs) that promise to bring countries closer to reaching the Millennium Development Goals and the global community closer to eliminating pediatric HIV and AIDS around the world.
The Foundation urges swift adoption of the WHO’s guidelines, which include a new emphasis on treatment for all eligible pregnant HIV-positive women and extended ARVs to protect HIV-exposed infants through the breastfeeding period. These changes would prioritize pregnant women, and result in many more mothers receiving lifesaving treatment by lowering the threshold for treatment eligibility. This will both protect the health of mothers and dramatically increase the chances of protecting their infants from HIV.
For those women whose CD4 counts do not yet make them eligible for treatment, the WHO recommends provision of antiretrovirals for a longer period during pregnancy – starting as early as 14 weeks rather than 28 weeks in previous guidelines – to more effectively prevent mother-to-child transmission.
For the first time, the WHO also supports giving antiretroviral drugs to mothers or children throughout the breastfeeding period, and recommends infant and young child feeding practices that make breastfeeding a safer option in resource-poor countries that rely on it for infant survival.
These recommendations present a momentous opportunity to increase the impact of Foundation-supported HIV services, reduce pediatric HIV infections worldwide, and improve maternal and child health. They will also be a critical tool to help the Foundation reach its goal of decreasing new global pediatric HIV infections by one-half between 2009 and 2013, thereby preventing nearly a million infections in children.
In the past, there have been significant delays and challenges in adopting WHO guidelines at the country level, and the Foundation is committed to accelerating and improving this process. The Foundation will work with national governments to translate the guidelines into implementation strategies appropriate for the local settings, and help ensure continuity of existing services throughout the process. Implementing the guidelines will present many challenges, including the need for health system strengthening, greater workforce capacity, and integration of HIV/AIDS prevention and treatment with maternal and child health services, among others.
We will need to work strategically with ministries of health and other partners and stakeholders to put all the prerequisites for success in place.
The World AIDS Day theme of universal access points to one of the main challenges ahead. Achieving full access to the prevention and treatment services outlined by the WHO will take a concerted effort by the global community. But it provides an excellent opportunity to achieve dramatic progress in our mission to eliminate pediatric AIDS, and bring us ever closer to our goal of a generation free of HIV.
About the Elizabeth Glaser Pediatric AIDS Foundation
The Elizabeth Glaser Pediatric AIDS Foundation is a worldwide leader in the fight against pediatric AIDS. Its innovative research programs, collaborative training initiatives, advocacy efforts, and rapidly expanding international prevention and treatment programs are bringing dramatic changes to the lives of children worldwide. For more information, visit www.pedaids.org/jointhemoment.