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Countries should phase out the use of stavudine, the most common AIDS drug, because of “long-term, irreversible” side effects in HIV patients including wasting and a nerve disorder, the World Health Organization said on Monday.

In sweeping changes to its guidelines, the WHO also recommended that people with HIV, including pregnant women, should start taking AIDS drugs earlier to live a longer and healthier life.

For the first time it advised HIV-positive women and their babies to take the drugs while breastfeeding to prevent mother-to-child transmission of the virus that causes AIDS.

Stavudine, also known as d4T, is marketed as Zerit by U.S. drugmaker Bristol-Myers Squibb Co. Generic versions are made by Cipla Ltd, Aurobindo Pharma Ltd and Strides Arcolab Ltd, all of India.

Stavudine, widely available in developing countries as a first-line therapy, is relatively cheap and easy to use, according to the U.N. agency.

But it causes a nerve disorder leading to numbness and burning pain in the hands and feet, and loss of body fat known as lipoatrophy or wasting, it said, conditions that are disabling and disfiguring.

The WHO recommended “that countries progressively phase out the use of stavudine as a preferred first-line therapy option and move to less toxic alternatives such as zidovudine (AZT) or tenofovir (TDF).” These are “equally effective alternatives.”

Zidovudine was first manufactured by GlaxoSmithKline Plc whose patent expired in 2005. Aurobindo and Ranbaxy Laboratories, also of India, are among makers of the generic version. Tenofovir is marketed by Gilead Sciences under the name of Viread.

About 20 HIV drugs are on the market, many made in combinations so patients can take a cocktail in one tablet.

TREND AWAY

Doctors once delayed giving them because of fears about toxic side-effects, and because the human immunodeficiency virus that causes AIDS can easily evolve resistance to drugs. Several recent studies have shown that early treatment can keep patients healthier.

Of more than 4 million people globally who take HIV drugs, known as antiretrovirals, about half are on a regimen containing stavudine, down from 80 percent in 2006 when the WHO first said countries should envisage moving away from it because of its long-term effects, according to Dr. Siobhan Crowley of WHO’s HIV/AIDS Department.

“It is the most widely used. There is a trend moving away from it. We think it will take some time,” she said.

An earlier start to treatment of HIV-infected adults and adolescents reduces their viral load — the amount of virus in the blood — much sooner and therefore may also lower the risk of them spreading the virus, according to the WHO.

“The new recommendations are based on a solid body of evidence indicating that rates of death, morbidity and HIV and tuberculosis transmissions are all reduced by starting treatment earlier. This prolongs and improves quality of life,” it said.

An estimated 33.4 million people worldwide, two thirds of them in sub-Saharan Africa, are infected with the AIDS virus, an annual United Nations report said last week.

A separate report issued in New York on Monday by the WHO and three other U.N. agencies said there had been progress against mother-to-child transmission of HIV. Globally, 45 percent of HIV-positive pregnant women now receive treatment to prevent transmission, a rise of nearly 200 percent since 2005.

Treatment for HIV-positive children, though still trailing adult treatment, had increased to cover 38 percent of those in need, a rise of nearly 40 percent in a year, the report said.

However, most countries would still not meet goals set out at the start of a campaign launched by the United Nations four years ago to combat the effect of AIDS on children, it said.

Imagine that you see a new mole and don’t like the looks of it so you take a picture of it using your cell phone and e-mail it to your family doctor for an opinion.

Or perhaps you have heart disease and take your blood pressure using a cuff that automatically uploads the data to your cardiologist’s computer for review.

Using electronic communications equipment to transmit medical information for consultation or examination — known as telemedicine — has come a long way from its beginnings as a means for rural areas to have access via teleconferencing to top-flight specialists.

In fact, technology has advanced to the point that telemedicine is beginning to blur into the normal daily routine of a doctor, said Dr. Jason Mitchell, assistant director for the Center for Health Information Technology of the American Academy of Family Physicians.

“Someday we won’t even consider it telemedicine anymore,” Mitchell said. “It’ll just be part of the way we practice medicine.”

And evidence is mounting that telemedicine can play a positive role in health care. A study in the journal Stroke found that the use of teleconferencing and the transmission of CT brain scans is beneficial to the initial treatment of stroke victims, later assessment of the amount of brain damage they’ve received and the rehabilitation they will go through during their long-term recuperation.

Some new ways of practicing medicine already taking place that could be considered telemedicine include:
Ambulances transmitting EKG data to the hospital they’re en route to
Automated pill counters that transmit data that lets doctors know whether medications are being taken as prescribed
Teleconferences to bring in specialists for consultation in such fields as dermatology, neonatal care, surgery and psychotherapists
Electronic scales for heart patients that trigger an alert to a nurse if the patient’s weight increases dramatically

“One of the best early indicators for impending hospitalization for patients with congestive heart failure is an increase in body weight,” said Dr. Lee H. Schwamm, vice chairman of the neurology department and director of TeleStroke & Acute Stroke Services at Massachusetts General Hospital in Boston and an associate professor of neurology at Harvard Medical School.

Schwamm describes such examples of telemedicine as “low-hanging fruit,” easily done to great advantage for both the patient and the doctors involved.

Telemedicine could be a boon to preventative medicine, Mitchell and Schwamm said, giving doctors access to detailed data that would allow them to diagnose problems early. For example, data from the scales or the blood pressure cuff could give doctors a chance to get someone in for treatment before a heart attack or stroke occurs.

“It would identify for us when a patient should be seen rather than relying on the patient for that judgment,” Schwamm said. “In my mind, that’s the real promise.”

Telemedicine also could provide tremendous cost savings. People might not have to take time off from work and drive to see their doctor to have a question or concern addressed. And people with serious illnesses might not have to travel hundreds or thousands of miles for a consultant’s opinion. “It’s expensive and inefficient to move people around when many visits require minimal care,” Schwamm said.

Some impediments must be overcome, however. Insurance companies have not ironed out how a doctor should be compensated for different types of telemedical service. “That takes time. That takes expertise,” Mitchell said. “There should be some level of compensation for making that happen.”

And there are administrative barriers, too, Schwamm said. For example, can a doctor licensed and credentialed in one state “see” patients from another state via an Internet video link?

Mitchell believes telemedicine ultimately will strengthen people’s relationships with their doctors, allowing them to share health information more easily. However, people first need to have a relationship with a doctor they trust.

“This is an adjunct to a relationship with a physician that’s already there,” Mitchell said. “I don’t think the electronic interactions are going to completely replace the personal interaction, but they can augment them. You don’t have to be standing in front of a physician to accomplish certain things, but that hands-on interaction needs to be there in many cases.”

Don’t write off doctor visits just yet, though.

“It’s important to never underestimate the healing power of human touch,” Schwamm said.