WHO Says Everyone with HIV Should Start ART

The World Health Organization (WHO) has issued new guidelines on the early treatment of HIV-infected individuals and pre-exposure prophylaxis (PrEP). The goal is to significantly increase the number of people eligible for anti-retroviral treatment (ART) and to prevent HIV infections among those at greatest risk.

The revised guidelines, published September 30, 2015, make 2 key recommendations:

• ART should be initiated in everyone living with HIV at any CD4 cell count. This recommendation is “based on evidence from clinical trials and observational studies released since 2013 showing that earlier use of ART results in better clinical outcomes for people living with HIV compared with delayed treatment.”
• Daily oral PrEP should be used as prevention for people at substantial risk of HIV infection as part of combination prevention approaches. This recommendation is “based on clinical trial results confirming the efficacy of the ARV (antiretroviral) drug tenofovir for use as PrEP to prevent people from acquiring HIV in a wide variety of settings and populations."

The recommendations are part of the revised consolidated guidelines on the use of ARV drugs for treating and preventing HIV infection, to be published by WHO in 2016.

The CDC praised the WHO guidelines, stating: “These recommendations are a major step forward in the global fight against HIV. They have the potential to dramatically reduce transmission of HIV worldwide, increase the widespread use of PrEP among those who need it most, and help those living with HIV live longer, healthier lives.”

Previously, WHO guidelines recommended ART for those with compromised immune systems (CD4 counts less than 500) and other vulnerable populations, such as children, pregnant women, and people with tuberculosis.

The revised guidelines call for initiation of ART in all adolescents and children age 1 to 10 living with HIV at any CD4 cell count, and in all pregnant and breastfeeding women living with HIV at any CD4 cell count and continued lifelong.

The WHO guidelines align with key US government recommendations on treatment guidelines recommending ART for all patients diagnosed with HIV infection, which was upgraded in 2015 based on clinical trial evidence. In 2014, the CDC issued first-ever clinical guidance recommending physicians consider advising the use of PrEP for gay and bisexual men, heterosexuals, and injection drug users at substantial risk for HIV infection.

Currently, 15 million people are now receiving ART. But more than 22 million people living with HIV are not yet being treated.

WHO hopes the new guidelines will significantly reduce the number of people acquiring HIV infection and dying from HIV-related causes and that they will significantly affect global public health.

“By publishing these recommendations as soon as possible, WHO aims to help countries to anticipate their implications in a timely fashion and begin the dialogue necessary to ensure that national standards of HIV prevention and treatment are keeping pace with important scientific developments,” the guidelines stated.