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IAS 2013: World Health Organization Guidelines for Earlier HIV Treatment

People infected with HIV should be put on antiretroviral therapy even sooner than they are now, the World Health Organization (WHO) said Sunday, June 30 as it released new treatment guidelines at the 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) in Malaysia.

The new WHO guidelines recommend that drugs be initiated as soon as a patient’s CD4 count falls below 500 cells/mm3. The previous cutoff point, recommended by the WHO in 2010, was a count of 350; a decade ago, it was 200.

For some subgroups, the new guidelines recommend starting treatment immediately upon a positive HIV test, regardless of CD4 count. Those include people with active tuberculosis or hepatitis B liver disease, women who are pregnant or breast-feeding, and children under age 5. And, in a nod to Treatment as Prevention, antiretrovirals are recommended, regardless of CD4 count, for those whose regular sex partners are not infected.

While a step forward, they also represent a compromise between how much the world could do to suppress the epidemic if money were no object and how much donor countries are willing to contribute to the effort.

Source: Reporting from Kuala Lumpur for the PRN News: Bill Valenti, MD