The World Health Organization (WHO) has released new HIV treatment guidelines that recommend offering antiretroviral therapy (ART) earlier. These can be found in WHO’s “Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection.”
The new recommendations encourage treatment initiation in adults with HIV when their CD4 cell count falls to <500 cells/mm3. The previous WHO recommendations from 2010 recommended treatment at <350 cells/mm3. Few countries, such as Algeria, Argentina, and Brazil are already offering treatment at 500 cells/mm3.
The recommendations are based on evidence that earlier treatment with safe, affordable, and easier-to-manage medicines can keep HIV-infected patients stay healthy and lower the viral load, which reduces the risk of transmission.
Additional recommendations also include providing ART (regardless of CD4 count) to all children with HIV <5 years of age, all pregnant and breastfeeding women with HIV, and all HIV+ partners where one partner is uninfected. The WHO continues to recommend that all patients with HIV with active tuberculosis or hepatitis B receive ART.
Another recommendation is to offer all adult patients starting ART the same daily single fixed-dose combination pill containing tenofovir, lamivudine (or emtricitabine), and efavirenz. This would be easier and safer to take than alternative combinations that have been previously recommended, and can be used in adults, pregnant women, adolescents, and older children.
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