Changes considered in HIV treatment(2)

Lost patients

Moreover, many patients who undergo the tests simply disappear and never return for the results and treatment, he warned, adding that late treatment means a higher risk of opportunistic infections and shorter life expectancy.

Under the new guidelines, however, the time lapse between diagnosis and the start of ART treatment at the You An Hospital is only about two weeks, a drop from about two months, he said.

So far this year, more than 1,000 patients have started ART at the hospital, and at least 80 percent asked for early treatment if possible.

A patient surnamed Feng, a 21-year-old gay man, started treatment in September with a CD4 count of more than 700 and has been doing well.

"The scientists say AIDS can be controlled with early ART, just as chronic diseases such as diabetes and hypertension are controlled with other drugs," said Feng, a university student in Beijing. "My only concern is if early treatment leads to quicker resistance to the medicine."

In response, Wu said: "Good drug compliance can avert resistance. But it's a double-edged sword because of the possible side effects of ART."

So far, only 30 of the more-than-3,800 patients treated at the You An hospital have developed a resistance to their medicines, mainly because of bad drug compliance, he said.

Peter Reis, vice-president of the AHF, said the pilot is aimed at changing the testing policy in China. "To get a confirmatory result takes too long, and the patient in question usually falls away and is lost to the system," he said, adding that it's preferable for all treatment sites to have the facilities to conduct double rapid tests to diagnose HIV, and then briefly put the patients on early treatment, he said.

"That puts the (treatment) sites in a powerful position to link the patients to care immediately, and it's what we do in the US," he said.

Wu Zunyou was in full agreement, and said pilots such as this had been already conducted in China's worst-hit areas, such as Yunnan province. However, fearing potentially inaccurate results, some AIDS doctors are reluctant to conduct the tests, he added.

He said the authorities have been working to further encourage the new strategy and widen the coverage of treatment available.

Catherine Sozi, UNAIDS country director of China, welcomed the initiative, saying that in many countries, "AIDS treatment is not seen as rocket science, and nurses can begin administering the treatment to patients," she said.

Usually, the nurse can start administering ART after two positive rapid tests using kits made by two different manufacturers, according to Sozi. "This is obviously what the Chinese government needs to think about, but the exact implementation plan should be tailored to the Chinese context," she said.

For example, in South Africa, where the HIV epidemic has been particularly serious, treatment was the province of the nurses, and only the most complicated cases were referred to the doctors.