WHO Resets ART Threshold at 500 CD4s, Endorses Single-Pill Combo
HIV-positive people should start antiretroviral therapy (ART) when their CD4 count falls to 500, according to new guidelines released by the World Health Organization (WHO). The previous CD4 threshold was 350.
Treatment should begin with a one-pill, once-daily coformulation of efavirenz, tenofovir, and emtricitabine, WHO recommends, because this convenient regimen will enhance adherence to therapy.
“If countries can integrate these changes within their national HIV policies, and back them up with the necessary resources,” says a statement accompanying the new guidelines, “they will see significant health benefits at the public health and individual level.”
The revamped advice also calls for immediate antiretroviral therapy for all children under 5 years old, regardless of CD4 count. In addition, all pregnant and breastfeeding women should start antiretroviral therapy. And all HIV-positive people with a steady HIV-negative partner should begin treatment without regard to CD4 count.
WHO’s Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection continue to recommend antiretroviral therapy for all HIV-positive people with tuberculosis or hepatitis B virus infection.
WHO experts calculate that implementing the new guidelines could prevent 3.5 million new HIV infections between now and 2025 and avert 3 million deaths.
The global health group estimates that that 9.7 million people now take antiretrovirals. Treatment coverage has increased in every region of the world, WHO reports. Four in 5 people who began antiretroviral therapy in 2012 live in sub-Saharan Africa.
But WHO warned that key populations with a high risk of HIV infection--people who inject drugs, men who have sex with men, transgender people, and sex workers--still face steep legal and social barriers to HIV testing and care.
Source: World Health Organization. WHO issues new HIV recommendations calling for earlier treatment. 30 June 2013.
Written by Mark Mascolini on behalf of the International AIDS Society