Resource Logo
Bangkok Post

Thailand - Government frets over new HIV costs: WHO broadens scope in new treatment guideline


Thailand is concerned about the costs of new World Health Organisation (WHO) guidelines for HIV treatment, Public Health Minister Pradit Sintawanarong said.

The WHO released its new HIV/Aids treatment guidelines on the opening day of the International Aids Society 2013 conference in Kuala Lumpur, Malaysia, Sunday.

The recommendations encourage all countries to initiate treatment in adults living with HIV when their CD4 cell count falls to 500 cells/mm or less.

The previous WHO recommendation, set in 2010, was to offer treatment at 350 CD4 cells/mm or less.

CD4 is a type of immune cell which is attacked by the HIV virus.

The recommendations also include providing antiretroviral therapy (ART), regardless of CD4 count, to all children with HIV under five years of age, all pregnant and breastfeeding women with HIV, and to all HIV-positive partners in a relationship where their partner is uninfected.

"These guidelines represent another leap ahead in a trend of ever-higher goals and ever-greater achievements," WHO director-general Margaret Chan said.

The WHO said its recommendations are based on evidence that treating people with HIV earlier, with safe, affordable, and easier-to-manage medicines can keep them healthy and lower the amount of virus in their blood, reducing the risk of them passing it to someone else.

However, Mr Pradit said that while Thailand welcomes the changes, he is concerned about the extra burden that would be placed on the national health care budget if they are adopted.

He said the Public Health Ministry would study the recommendations in detail, especially on the adjustment of CD4 count from 350 to 500, before adopting them.

The CD4 count adjustment would lead to more people receiving ART drugs, which are paid for by the government, Mr Pradit said.

The National Health Security Office (NHSO) agreed it would take time before the country adopted the new guidelines.

"In Thailand, our goal should not focus on extending ART to patients with CD4 500," Sorakij Bhakeecheep, director of the NHSO's Fund Management of HIV/Aids and Tuberculosis, said.

"We now focus more on seeking to extend the lives of those with CD4 100-350."

The ministry took about four years to prepare resources to adopt the previous WHO recommendations in 2010 to give ART drugs to people with a CD4 count of 350, up from 200.

Aids Access Foundation director Nimit Tian-Udom said the new guidelines should be adopted only when the government can afford them.

For now, Thailand should work on encouraging at-risk people to have HIV tests, he said.

According to ministry figures, more than 352,000 people nationwide are currently receiving ART drugs.

However, a recent NHSO survey found more than half of the number of new HIV infections began ART only when their CD4 count dropped to less than 100.

Just 5% of them received ART when their CD4 count was 350 or more.

International medical humanitarian organisation Doctors Without Borders Sunday backed the new WHO guidelines. "Early HIV treatment makes a major difference," Doctors Without Border president Unni Karunakara said.

"It keeps people healthier and also helps prevent the virus from spreading, but we need political and financial support to see these recommendations rolled out rapidly."


Copyright © 2013 -Bangkok Post, Publisher. All rights reserved to The Bangkok Post. Reproduction of this article (other than one copy for personal reference) must be cleared through the Bangkok Post.

Information in this article was accurate in July 1, 2013. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.