July 20, 2015

World Health Organization to recommend HIV treatment for all

Written by Keith Alcorn, NAM aidsmap

This post originally appeared on NAM aidsmap’s website here.

The World Health Organization will issue new HIV treatment guidelines later this year recommending treatment for all, regardless of CD4 cell count, Dr Meg Doherty of the WHO Department of HIV/AIDS told a satellite meeting ahead of the 8th International AIDS Society Conference (IAS 2015) in Vancouver on Sunday.

The new recommendation follows results from two large randomised trials, TEMPRANO and START, both released in 2015, which both showed that starting treatment at a CD4 cell count above 500 cells/mm3 resulted in less serious illness and AIDS-related deaths than if treatment was deferred.

The new guidelines, based on systematic review of trials and observational cohort data presented since the publication of consolidated WHO antiretroviral treatment guidelines in 2013, will recommend:

  • Treatment for all adults and adolescents regardless of CD4 count, prioritising those with CD4 counts below 350 cells/mm3 and those with AIDS-defining illnesses.
  • Treatment for all children.
  • Treatment for all pregnant women, leading to lifelong treatment (Option B+).
  • Pre-exposure prophylaxis should be offered as an additional prevention choice for people at substantial risk of HIV infection.

The new guidelines will lend further weight to the UNAIDS 90-90-90 target, which aims to diagnose 90% of people with HIV, treat 90% of people diagnosed with HIV and achieve undetectable viral load in 90% of people on treatment by 2020.

UNAIDS announced last week that its previous treatment access target – 15 million people on treatment by 2015 – was surpassed in March 2015. At the end of 2014, 40% of people living with HIV were on treatment worldwide.

The new target implies that 36.9 million people will need to receive antiretroviral treatment by 2020. The new guidelines will present major challenges for countries, but evidence presented on Saturday at a pre-conference meeting on treatment as prevention shows that the 90-90-90 target is already in reach for some African countries. Similarly, Brazil is making rapid progress towards providing treatment for everyone with HIV since changing its national guidance in late 2013, said Fábio Mesquita of Brazil’s Ministry of Health. The number of people starting treatment rose by 30% in 2014, to 74,000 in one year. To achieve its 90-90-90 target, Brazil needs to treat a further 177,000 by 2020, and diagnose around 71,000 who do not know their HIV status.

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