Prior to the opening of IAS 2013, the World Health Organisation (WHO) launched its new Consolidated Antiretroviral Guidelines.
WHO now recommends that everyone initiate treatment at CD4 counts of 500 or less — up from its 2010 recommendation of 350 (and 200 before that) — and that antiretroviral therapy (ART) be provided, irrespective of CD4 count, to all children under five years, all pregnant and breastfeeding women, and anyone in a serodiscordant relationship. It also recommends the same first-line combination for everyone: ideally a once-a-day, fixed-dosed of efavirenz and tenofovir with either emtricitabine or lamivudine.
Switching to these guidelines will increase the eligibility for treatment from 16.7 to 25.9 million people globally.
Currently, around 9.7 million people are on ART – 1.6 million more than in 2011. Between 1996 and 2012, ART prevented 4.2 million deaths. Over the same period, prevention of mother-to-child transmission averted more than 800,000 children becoming positive.
The WHO guidelines are clearly designed to roll out as much treatment to as many people in the simplest possible way and are more applicable to a public health model of care than the one we have in Australia.
But, hopefully these new guidelines will encourage more PLHIV to enter into care including those with higher counts. The fact remains that too many people are starting treatment too late. In Asia the average CD4 count at initiation is just 100. Even in Australia, where the starting guide of 500 has been around for some time, our median CD4 count at initiation still sits at just 294.