Millions More People Should be on HIV Meds (or PrEP) Than Previously Thought

New World Health Organization (WHO) guidelines recommend that antiretroviral medicines be prescribed to people as soon as possible after an HIV diagnosis, regardless of the person’s CD4 count. In addition, the guidelines now recommend that people at higher risk of HIV infection be given access to PrEP.

With this "treat-all" recommendation, WHO has removed their limitations on eligibility for antiretroviral therapy (ART) to make all populations and age groups living with HIV eligible for treatment.  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.

In a press release, UNAIDS lauded the new guidelines, saying the new recommendations are a major 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.”

The WHO guidelines reflect the positive results of studies conducted in the past 12 months, including data from the international randomized clinical trials Temprano and START (Strategic Timing of Antiretroviral Treatment), which reiterated the long-term benefits of starting antiretroviral therapy immediately upon receiving an HIV diagnosis. 

Other research studies (including the San Francisco study following 600 high risk individuals over 2.5 years) have continued to show what the press release calls “the significant efficacy of PrEP in reducing new HIV infections.”

The new guidelines recommend that PrEP be offered to “anybody at substantial risk of HIV exposure.”         

“We are at a crossroads in the response to AIDS,” Sidibé added. “We know what works – now we need to put people first and fully respect their right to health.”

According to the press release, UNAIDS “reaffirms the importance of respecting a person’s right to know their HIV status and to decide whether and when to begin antiretroviral therapy.”

The international organization supports voluntary and well-informed HIV prevention and treatment decisions and believes wider and more equitable delivery of antiretroviral therapy and PrEP requires addressing “the social and legal barriers that inhibit access to health services for people living with HIV and for marginalized populations at higher risk of infection.”              

The new recommendations were developed as part of a comprehensive update of the "WHO consolidated guidelines on the use of antiretroviral drugs for preventing and treating HIV infection," which will be released later this year. The agency says it decided to release these guideline early “because of their potential for public health impact.”

UNAIDS has set ambitions targets for 2020:
• 90 percent of all people living with HIV knowing their HIV status
• 90 percent people who know their HIV-positive status having access to treatment
• 90 percent of people on treatment having suppressed viral loads
• reducing new HIV infections by 75 percent
• achieving zero discrimination.