New UN treatment guidelines say all people with HIV should get antiretrovirals

Anyone infected with HIV should begin antiretroviral treatment as soon after diagnosis as possible, the United Nations World Health Organization (WHO) announced today, as it issued new guidelines that could help avert more than 21 million deaths and 28 million new infections by 2030.

With its “treat-all” recommendation, WHO removes all limitations on eligibility for antiretroviral therapy (ART) among people living with HIV.

“All populations and age groups are now eligible for treatment,” the Geneva-based agency said in a news release.

According to WHO, the expanded use of antiretroviral treatment is supported by recent findings from clinical trials confirming that early use of ART keeps people living with HIV alive, healthier and reduces the risk of transmitting the virus to partners.

WHO is also now recommending that people at “substantial” risk of HIV should be offered preventive antiretroviral treatment. This builds on previous guidance to offer a combination of antiretroviral drugs to prevent HIV acquisition, pre-exposure prophylaxis (PrEP), for men who have sex with men.

Following further evidence of the effectiveness and acceptability of PrEP, WHO has now broadened this recommendation to support the offer of PrEP to other population groups at significant HIV risk. PrEP should be seen as an additional prevention choice based on a comprehensive package of services, including HIV testing, counselling and support, and access to condoms and safe injection equipment.

The new guideline stresses that, in order to effectively implement the recommendations, countries will need to ensure that testing and treatment for HIV infection are readily available and that those undergoing treatment are supported to adhere to recommended regimens and are retained in care.

Based on the new recommendations, the number of people eligible for antiretroviral treatment increases from 28 million to all 37 million people who currently live with HIV globally.

Expanding access to treatment is at the heart of a new set of targets for 2020 aimed at ending the AIDS epidemic by 2030. These targets include 90 per cent of people living with HIV being aware of their HIV infection, 90 per cent of those receiving antiretroviral treatment, and 90 per cent of people on ART having no detectable virus in their blood.

According to estimates by the Joint UN Programme on HIV/AIDS (UNAIDS), expanding ART to all people living with HIV and expanding prevention choices can help avert 21 million AIDS-related deaths and 28 million new infections by 2030.

In a news release, UNAIDS welcomed the release of the new guidelines as a significant step towards improving the lives of people living with HIV and reducing the transmission of the virus.

“These new guidelines and recommendations are a highly significant moment in the AIDS response,” said Michel Sidibé, Executive Director of UNAIDS. “The medicines and scientific tools now at our disposal provide us with a real opportunity to save millions of lives over the coming years and to end the AIDS epidemic by 2030.”