The World Health Organization (WHO) issued new global guidelines for antiretroviral therapy on June 30 at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur.
The updated guidelines recommend offering antiretroviral therapy (ART) to all HIV positive people with CD4 T-cell counts below 500 cells/mm3, and recommend that all adults start on a regimen of efavirenz, tenofovir, and emtricitabine or lamivudine, preferably as a fixed-dose combination.
Currently in the underdeveloped world, where HIV has devastated many nations, 9.7 million people out of an estimated 16.7 million who should be treated receive effective antiretroviral therapy, said Gundo Weiler, MD, PhD, medical and health policy adviser of the National German AIDS Organization in Berlin. But the impact of the new World Health Organization (WHO) guidelines will increase the number of patients who need to be treated to 25.9 million.
The major increase comes from earlier treatment — commencing highly active antiretroviral therapy (HAART) when infected persons’ CD4-positive cell counts drop below 500 cells/mm3, Weiler, who helped write the recommendations, said at the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. The previous guidelines suggested treating patients once those immune system markers fell below 350 cells/mm3.
The new guidelines recommend:
- Treating adults, adolescents, and older children earlier — starting antiretroviral therapy in all individuals with a CD4 cell count of 500 cells/mm3 or less and giving priority to individuals with severe or advanced HIV disease and those with a CD4 cell count of 350 cells/mm3 of less.
- Starting antiretroviral therapy at any CD4 cell count for certain populations with HIV, including people with active tuberculosis disease, people with hepatitis B coinfection with severe chronic liver disease, HIV-positive partners in serodiscordant couples, pregnant and breastfeeding women, and children younger than 5 years of age.
- A new preferred first-line antiretroviral regimen harmonized for adults, pregnant and breastfeeding women and children ages 3 or older. That first-line therapy should be a fixed-dose combination of tenofovir plus lamivudine or emtricitabine plus efavirenz.
- Support to actively accelerate the phasing out of stavudine (d4T) in first-line regimens for adults and adolescents.