{"id":1126,"date":"2015-11-05T15:10:33","date_gmt":"2015-11-05T15:10:33","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1126"},"modified":"2015-11-05T15:10:33","modified_gmt":"2015-11-05T15:10:33","slug":"changes-in-the-who-guidelines-for-treatment-of-hiv","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2015\/11\/05\/changes-in-the-who-guidelines-for-treatment-of-hiv\/","title":{"rendered":"Changes in the WHO Guidelines for treatment of HIV"},"content":{"rendered":"<p>The WHO has released early its revised guidelines on the treatment of those infected with HIV (<a href=\"http:\/\/www.who.int\/hiv\/pub\/guidelines\/earlyrelease-arv\/en\/\">WHO early release guideline<\/a>; <a href=\"http:\/\/www.who.int\/mediacentre\/news\/releases\/2015\/hiv-treat-all-recommendation\/en\/\">WHO press release<\/a>).\u00a0 There are two important changes.\u00a0 First, ART is recommended to all HIV infected individuals regardless of their CD4+ count.\u00a0 Second, PrEP is recommended for people at \u2018substantial\u2019 risk of HIV infection as part of a comprehensive package of services.<\/p>\n<p>The first of these revisions comes in the train of repeated rises over recent years in the recommended treatment threshold: first (2010), to<strong>350<\/strong> CD4 per mm<sup>3<\/sup>; then (2013), from <strong>350<\/strong> to <strong>500<\/strong>. \u00a0The latest revision is doubtless based on the results of randomized controlled trials (RCT) such as the <strong>START<\/strong> (Strategic Timing of Anti-Retroviral Therapy) trial (<a href=\"https:\/\/blogs.bmj.com\/sti\/2015\/08\/28\/a-case-for-immediate-art-initiation-in-all-hiv-diagnosed-regardless-of-cd4-count\/\">A Case for Immediate ART Initiation (STI\/blog)<\/a>).\u00a0 The second builds on a WHO 2014 guideline which already recommended PrEP for MSM populations.\u00a0 Here again recent RCTs demonstrating the effectiveness of PrEP, such as PROUD and IPERGAY (<a href=\"https:\/\/blogs.bmj.com\/sti\/2015\/10\/22\/prep-highly-effective-against-hiv-in-msm-and-has-limited-impact-on-risk-compensation\/\">PrEP highly effective for HIV in MSM (STIs\/blog)<\/a>) will have played their part.<\/p>\n<p>The removal of the threshold has resource implications that will pose a serious challenge in resource poor settings.\u00a0 Writing in 2010 <a href=\"http:\/\/sti.bmj.com\/content\/86\/5\/388.abstract?sid=616dac12-d64a-4223-9910-78d0a5a1b673\">Hamilton and Crowley (STIs)<\/a>\u00a0estimated that setting the threshold for ART initiation at\u00a0<strong>250 CD4+<\/strong>\u00a0would by 2012 increase the need for treatment by a median of\u00a0<strong>15%<\/strong>, whereas setting at\u00a0<strong>350 CD4+<\/strong>\u00a0would increase it by\u00a0<strong>42%<\/strong>\u00a0and\u00a0<strong>500 CD4+<\/strong>\u00a0by\u00a0<strong>84%<\/strong>. Contributors like\u00a0<a href=\"http:\/\/sti.bmj.com\/content\/87\/7\/621.abstract?sid=8a543995-33e0-4a93-b9e6-4b9a0a02159a\">Hallett &amp; Garnett (STIs)<\/a>\u00a0(Zimbabwe) and\u00a0<a href=\"http:\/\/sti.bmj.com\/content\/84\/Suppl_1\/i31.abstract?sid=e9d06ad4-3322-429d-a269-0751ecfaea54\">Zwahlen (STIs)<\/a>\u00a0have sought to develop projections for individual countries.<\/p>\n<p>Also, it has been argued that late diagnosis (even by current standards), and poor retention in care are significant factors in suboptimal health outcomes (<a href=\"http:\/\/sti.bmj.com\/content\/89\/Suppl_1\/A382.3.abstract?sid=e9d06ad4-3322-429d-a269-0751ecfaea54\">Mubezi &amp; Shuha (STIs)<\/a>;\u00a0<a href=\"http:\/\/sti.bmj.com\/content\/88\/Suppl_1\/A11.2.abstract?sid=e9d06ad4-3322-429d-a269-0751ecfaea54\">Hussey (STIs)<\/a>. \u00a0What the revised guidelines will deliver in real terms no doubt depends on the context of implementation. \u00a0Yet, even in the relatively more affluent settings (US), some recent research has argued for the reallocation of resources from linkage to retention in HIV care, in order to optimize utilization of scarce resources (<a href=\"https:\/\/blogs.bmj.com\/sti\/2015\/03\/25\/retention-in-care-rather-than-diagnosis-may-prove-the-ultimate-challenge-for-us-hiv-response\/?utm_source=feedburner&amp;utm_medium=feed&amp;utm_campaign=Feed%3A+sti%2Fblogs+%28Latest+from+STI+blog%29\">Retention in Care (STI\/blogs)<\/a>;\u00a0<a href=\"http:\/\/sti.bmj.com\/content\/88\/2\/106.abstract?sid=b7afec6c-c754-4e16-9b76-23214642e97c\">Sherer (STIs)<\/a>. This could prove hard to square with the prioritization of ever lower thresholds for linkage to care \u2013 even if the recommended policy is in the interests of improving individual outcomes.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The WHO has released early its revised guidelines on the treatment of those infected with HIV (WHO early release guideline; WHO press release).\u00a0 There are two important changes.\u00a0 First, ART is recommended to all HIV infected individuals regardless of their CD4+ count.\u00a0 Second, PrEP is recommended for people at \u2018substantial\u2019 risk of HIV infection as [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2015\/11\/05\/changes-in-the-who-guidelines-for-treatment-of-hiv\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[264,2042,2380,4357],"tags":[],"class_list":["post-1126","post","type-post","status-publish","format-standard","hentry","category-health-policy","category-hiv-care","category-pre-exposure-prophylaxis","category-risk-compensation"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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