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The World Health Organization has declared and organized the AIDS Day on December the 7th. The disease is today considered as a major disaster for the entire humanity due to the increasing and alarming number of deaths every year. AIDS has already killed 23 million of people in the world and last year, 3 million people died of the infection which is 8,200 a day. According to WHO, over 40 million people are infected which is more than 15,000 everyday and most of the patients are in the age gap of 20 and 50.


Since no effective vaccine has yet been developed for the prevention of the AIDS, the treatment of HIV infected patients has become a major priority for WHO. An extensive treatment which has been developed some six years ago is today widely used by most developed countries to delay the onset of the disease among the HIV infected patients. The treatment which consists of a combination of 3 to 4 antiretroviral drugs is known as Highly Active Antiretroviral Therapy (HAART).


But, it was found that the HAART can cause severe side effects among the HIV infected patients including nerve damage, weakened bones, high cholesterol, heart diseases and diabetes mellitus. This is why the treatment is delayed in patients without the AIDS symptoms. It is actually recommended to start the treatment when the level of CD4 T-Lymphocytes level fall below 350 per cubic mm or/ and a virus load of 50,000 per cubic mm in blood. The CD4 T-Lymphocytes are the main lymphocytes in the blood that are infected and destroyed by the Human Immunodeficiency Virus (HIV).


However, a group of researchers at the University of British Columbia in Canada recently reported that HAART can be delayed until the CD4 level falls below 200 per cubic mm. The article was published in the December issue of the Journal of American Medical Association (JAMA). This is considered as an important finding as any delay in the initiation of the treatment will not only reduce the chances of severe side effects but will also lead to a reduction in the cost of treatment. The study was carried out on 1219 HIV infected patients who are over 18 years old and live in the province of British Columbia. The treatment was initiated with a triple antiretroviral drug between August 1996 and September 1999, that is, over a period of three years. The researchers concluded that the effect of the therapy among the patients is much better when the CD4 cells are at least 200 per cubic mm.


In Mauritius, the Ministry of Health has recently announced that it will soon start providing the treatment free of charge to HIV infected patients. It is therefore very important to consider when to start the treatment. Conventionally, the treatment would be started when the CD4 levels drop below 350 per cubic mm. But with this new finding, the treatment can be delayed for about more than one year until the CD4 cells level lowers to 200 per cubic mm. The treatment can therefore be more beneficial to both the patients and the government in terms of cost as it is considered as very expensive.


Hence, although more studies are needed to confirm this new finding, Medical Professionals in Mauritius should try to workout a strategy on when to start the treatment among the patients. In this way, the therapy can be more effective to the patients and less costly to the government.



Mohamed Yousuf BHUGUN.

MSc (UK), FIBMS, RT (Can.).