The Department of Health is reviewing its guidelines for
antiretroviral treatment, and at the heart of discussions is
whether people should be able to start taking medication sooner.
It is expected that the revised national guidelines will change
to allow people with a higher CD4 cell count to qualify for ARV
treatment. A CD4 cell count is the number of healthy cells in the
body that can fight against infection. Currently, you must have a
CD 4 count of 200 or less to get antiretrovirals in the public
health sector. Work on revising the guidelines is at an advanced
stage, said the Chief Director of the HIV/AIDS programme in the
national Department of Health, Dr Nomonde Xundu, in a telephone
"Yes, indeed we started the process consulting, getting views,
getting inputs and we put together recommendations that have been
processed internally in the Department of Health and I'm saying
after much consultation with expert groups and so on, the
Department of Health has interrogated the recommendations quite
extensively and made some further inputs which were incorporated.
We then submitted that document for a higher level discussion by
principals at a meeting called the co-group, which is basically
the Minister (of Health) sitting with the D-G and the Deputy
Director-Generals in the Department, after which then an approach
will be decided on taking it to the National Health Council,
which is the Minister with the MECs of the provinces - remember
the provinces are the implementing agencies and heads of health...
Again, let me quickly say, that we discussed it in the treatment
task team of SANAC", she explained.
However, Xundu would not be drawn into revealing what specifics
the document is recommending.
But sources close to the discussions have revealed that one of
the key issues is to increase the CD4 cell count at which people
should start taking treatment, said chairperson of the Treatment
Action Campaign, Nonkosi Khumalo.
"The recommendations around the globe, which is what we are also
advising, is that people start treatment at around 350 than the
proposed 200 at the moment, because that's already late... The
benefits are that at that particular point in time a person is
more tolerant with the drugs, which are potent and have
side-effects - which are manageable. But if you start when you
are still much, much healthier because when you reach a CD 4
count of 200 you are more susceptible to more opportunistic
infections, and so it means your pill burden is much more at that
point in time than you are at 350 where there are very few cases
of people who would have active TB and actually needing to take
antiretrovirals. So, it's motivated by the fact that we want to
decrease the pill burden for people, but we want to treat them
when their immune system is still responding, to a certain
extent, to the medication".
In addition to ensuring that people get access to treatment
timely and efficiently, the TAC has advised the Department of
Health to work towards broadening the choice of antiretroviral
medicines in order to deal with side-effects and resistance to
existing regimens. South Africa has only two regimens, referred
to as 1(a) or 1(b) and 2. If people develop resistance to these,
there is no alternative treatment to offer them.