Joint Open letter to the Heads of Government of Latvia
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24.11.2012

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Our country is a member state of European Union (EU) and we have to have adequate HIV treatment like it is in the rest of Europe. Latvia is the only state in EU where HIV infected people do not receive treatment if their CD4 cells drops below 350c/mm3. Today our national “Rational Pharmacotherapy recommendations for Antiretroviral treatment (ART) HIV/AIDS infection funded from state budget” (2009) recommend initiating treatment at CD4 ≤ 200c/mm3.
We declare: it is unfavorable fact and the situation must be solved immediately.
According to the European Centre for Disease Control Latvia is ranked in the 2nd place according to new HIV cases and 1st – AIDS patients in EU.  As of November 1, 2012 5457 people living with HIV/AIDS had been registered in Latvia but only around 600 receive ART where evidence suggests there are at least twice as much who need this treatment. The major obstacle, which has been raised by national and international experts and organizations, is related with the outdated recommendations prescribing that treatment is initiated only when CD4 count drop well below internationally accepted standards as well as to low treatment adherence rates as the largest part of people on treatment suffer also from drug addiction.  HIV prevalence rate in drug users’ community is above 20% and has been on the increase during the last years, while in 55% of the new cases the transmission route of HIV infection is attributable to injecting drug use. Nevertheless, no integrated ART and drug treatment programs are offered in our country.
Accepted State budget for 2013 does not provide any increase in financing for reimbursement medicines therefore no improvements or changes in ART to initiate treatment from CD4 ≤ 350 are planned. Even more, letter from Ministry of Health states: “draft law screened in the 2nd reading (today – it’s already accepted) in the Parliament “About mid-term budget for 2013–2015” does not foresee any increase for reimbursement medicines neither in 2014 nor 2015”.  Such unacceptable statements lead to conclusion that Latvia does not have plans to review the aforementioned recommendations and initiate ART from CD4 ≤ 350cells/mm3 for the next 3 years.
In Latvia ART is reimbursed, but we do not see any understanding and interest from the government to start HIV treatment earlier. Growing evidence suggests that ART can also prevent HIV transmission and that earlier initiation of treatment is beneficial for those affected by the virus and society at large.
We urge Government of Latvia to follow international guidelines for ART saving people lives:
* WHO Guidelines on antiretroviral therapy (2009, 2010, 2012) recommend: therapy should be initiated, when CD4 cell counts reach or drop below 350 cells/mm3, regardless of weather patients have or not clinical symptoms.
* EACS guidelines (2011) recommend to start ART when confirmed CD4 <350/mm3.