Since the introduction of the Melbourne Declaration (www.melbournedeclaration.com ) in 2012 within Australia, following the 2011 United Nations Political Declaration on HIV/AIDS, revitalised target action on HIV has taken place in order to eliminate HIV/AIDS, reduce new infections, and to remove barriers to treatment access.
Major tripartisan – community, research, and governmental – action has occurred, and continues to occur in this direction, aiming to reduce the impact and burden of HIV locally and globally.
A cornerstone target of these actions is to improve access to HIV antiretroviral treatment, by building the capacity of individuals to commence HIV treatment at any CD4 count through patient-centred decision-making, alongside discussion with their care and treatment providers.
Whilst clinical treatment guidelines vary worldwide, all centre upon individual patient decision as to when to start treatment, with certain beneficial, and in some cases less beneficial – caveats or restrictions in access.
In Australia the treatment guidelines upper limit to access – at 500 CD4 cells – is a major barrier to the expansion of HIV antiretroviral treatment access and has now been removed.
At the November 2013 Pharmaceutical Benefit Advisory Committee (PBAC) meeting a positive recommendation was made endorsing the “removal of the CD4+ cell count restriction for initiation of first line anti-retroviral therapy (ART) in asymptomatic, ART naïve HIV positive patients”.
Basically, this means that any person living with HIV can now access HIV treatment (once the PBS listing process is completed shortly), with or without symptoms at any CD4 count. A person retains the right to choose, according to their desire to treat – or to delay treatment – by discussion with their clinical treatment care provider (HIV doctor).
In making their decision to remove the CD4 count barrier, the PBAC noted:
- the potential benefits of removing the CD4+ restriction including reduced transmission of HIV infection, individualisation of patient therapy and greater choice for patients and prescribers of when to initiate therapy with ART; and
- current expert opinion suggesting a likely net clinical benefit to patients from removal of the threshold compared to current clinical practice
The National Association of People with HIV Australia (NAPWHA) have released their Media Statement in association with The Australian Society of HIV Medicine (ASHM) and The Australian Federation of AIDS Organisations (AFAO) here: http://www.napwha.org.au/