WHO Releases New HIV Treatment and PrEP Guidelines
New guidelines dramatically increase number of people eligible for treatment
The World Health Organization (WHO) has issued new guidelines recommending that all people living with HIV initiate antiretroviral therapy (ART) as soon as possible after infection, regardless of their CD4 count. The guidelines, released September 30, also recommend providing all HIV-negative individuals at “substantial” risk of HIV infection with pre-exposure prophylaxis (PrEP), as part of a comprehensive prevention package that includes regular HIV testing, counseling, and access to condoms and safe injection equipment.
The two recommendations reflect the strong clinical evidence that both interventions keep people healthy and prevent transmission of the virus. They were released in advance of an update to the more comprehensive consolidated ART guidelines, which are expected later this year.
“These guidelines propose an unprecedented expansion of HIV treatment,” says Dr. Annette Sohn, director of amfAR’s TREAT Asia program. “We should all work together to address the remaining barriers to treatment access, and advocate for the global HIV funding that will be needed to fulfill the goals outlined in the new recommendations.”
The recommendations, titled “Guidelines on When to Start Antiretroviral Therapy and on Pre-Exposure Prophylaxis for HIV,” increase the number of individuals eligible for ARV under WHO guidelines from 28 million to all 37 million people living with the virus worldwide. Currently, approximately 15 million people with HIV are accessing ART. According to UNAIDS, expanding eligibility to all people living with the virus, and making the prevention options available to those who are not, will avert 21 million deaths and 28 million new infections by 2030.
Increasing access to treatment and ending AIDS by 2030 is among the new UN Global Goals for Sustainable Development, released earlier this month. The plan incorporates the 90-90-90 targets set by UNAIDS in 2014: by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people diagnosed with HIV will have access to ART, and 90% of those on treatment will be virally suppressed. However, the new WHO guidelines stress that these ambitious goals will not be achieved without countries ensuring that HIV testing and treatment are widely available and affordable, and that individuals taking ART or PrEP are supported in adhering to treatment and remaining in care.