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Extend HIV treatment to all, WHO will recommend

By Barbara Axt

Everyone confirmed HIV positive should receive drug treatment immediately after diagnosis, according to upcoming guidelines by the World Health Organization (WHO). These would bring the number of people eligible for treatment from about 28 to 37 million worldwide — although only about 15 million people are actually receiving treatment.

Current guidelines recommend starting antiretroviral treatment only in the most vulnerable groups among those infected with HIV. These include children, pregnant women, people with coinfections such as tuberculosis and those whose immune systems the infection has already weakened.

“The studies show it is very beneficial for people to start treatment soon after they find out that they’re HIV positive.”

Gottfried Hirnschall, WHO

But recent large studies show that beginning treatment when the immune system is still strong not only improves the health of patients, but can also help prevent HIV transmission to sexual partners. These findings have prompted a change in WHO guidelines, which were discussed at an International AIDS Society conference in Canada last week (19-22 July). The guidelines will be launched officially in December.

The START (Strategic Timing of AntiRetroviral Treatment) study followed 4,685 HIV-infected patients from 35 countries, and showed that early treatment reduces the risk of death or serious health problems by 57 per cent.

Another clinical trial, known as HPTN 052 (HIV Prevention Trials Network), began in 2005 to study 1,763 couples in which only one person was HIV positive. One group of patients started treatment immediately, while the others received drugs only once there was a fall in the number of white blood cells called CD4 cells that help protect against infection.

By 2011, the transmission rate among the couples on early treatment appeared 96 per cent lower than the other group’s — a result so impressive that, for ethical reasons, the treatment was then offered to all couples in the trial. The final results showed an average decrease of 93% in HIV transmission.

“The studies show it is very beneficial for people to start treatment soon after they find out that they’re HIV positive,” WHO HIV director Gottfried Hirnschall tells SciDev.Net. For the first time, WHO will also recommend antiretroviral treatment for people who are uninfected but who have a high risk of contamination, such as sex workers, he adds.

Sharonann Lynch, HIV/AIDS policy advisor at medical aid organisation Médecins Sans Frontières, is optimistic that most countries will be able to implement the new treatment guidelines. After all, she says, it is simpler to treat all HIV positive patients than to have to begin treatment based on CD4 cell counts.

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But Anchalee Avihingsanon, the head of the medical department of HIV-NAT (Netherlands Australia Thailand Research Collaboration), who works in Thailand, sounds a note of caution. “The new guideline of early treatment is clearly beneficial for the patients’ health and HIV transmission,” she says, but patients may not comply well with the treatment so early after their diagnosis, and poor compliance may cause the virus to become resistant to the drugs.

The big challenge is finding out who needs treatment in the first place, Avihingsanon says. “Globally, only 50 per cent of the people who are HIV positive know their status. [WHO’s] target is to achieve 90 per cent,” Hirnschall adds.

This article was originally published on SciDev.Net. Read the original article.

Map shows India at top of climate violence

By S. Singh

India, Colombia and Nigeria have the most cases of conflict caused by climate change and environmental disputes, according to a map of global ecological conflict.

The Environmental Justice Atlas, released in Current Science last month, shows that more than 200 conflicts in India are caused by ecological disputes and scarcities of basic resources such as water and forests (see map). Colombia has 101 and Nigeria has 71 environmental conflicts, the researchers say.

The atlas is a work in progress and aims to map 2,500 environmental conflicts and injustices by the end of 2017,

According to V. V. Krishna, EJOLT project director and professor at the Centre for Studies in Science Policy at Jawaharlal Nehru University, New Delhi, one reason for India recording the maximum number of conflicts is the thrust on industrialisation, mining for natural resources and industrial units exploiting loopholes in environmental governance.

Conflicts related to water management appear highest in India with 59 cases, followed by conflicts in fossil fuels and climate justice category with 47 cases and the industrial and utilities conflicts category with 36 cases.

Explaining the observation, Krishna said water is important and India is known for bad management of water resources. "This leads to shortage, leading to conflicts. There is also the appropriation of water sources and channels by industrial units with political nexus," he said.

Map small: Location of conflicts
caused by environmental reasons in
India and South-East Asia — Click here to enlarge

Anup Kumar Das, an author of the Current Science article includes cases related to infrastructure and built environment, waste management, nuclear, biomass and land conflicts, tourism recreation and biodiversity conservation conflicts in the categories.

So far, the EJAtlas details 1,671 conflicts. Joan Martinez-Alier, professor at the Autonomous University of Barcelona, Spain and member of the EJOLT co-ordinating team, many conflicts may be underreported, especially in India. “This is the largest country in the world in terms of population, and very likely in terms of environmental conflicts,” he says.

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Krishna adds that countries which are good at gathering and distributing evidence around climate change and resources tend to be better at avoiding violent conflict arising from these issues. "If there is a fit between knowledge generation and decision making, it helps,” says Krishna. “In India there is a very weak or no link between these two domains of policymaking.”

This piece was produced by SciDev.Net’s South Asia desk.

This article was originally published on SciDev.Net. Read the original article.

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THE MEDICINES OF TODAY ARE BEING PRESCRIBED BY THE WRONG DOCTORS ...

BECOME INVOLVED

THEY ALSO MAKE MENTAL ILLNESS INCREASE AND CAUSE MORE SUICIDES ...

STOP THIS MADNESS !!