WHO revises ‘Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV’ (30 September 2015)

The World Health Organization (WHO) has revised the guideline on when to start antiretroviral therapy (ART) and on pre-exposure prophylaxis (PrEP) for HIV.

This early-release guideline will form part of the revised updated WHO consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection due to be published in 2016.

Definitions used:

Adult: Person older than 19 years of age

Adolescent: Person 10-19 years of age (both inclusive)

Child: Person less than 10 years of age

Infant: Child less than 1 year of age

Serodiscordant couples: Couples in which one person is living with HIV infection, and the other is HIV negative.

Key Messages:

  1. When to start ART among people living with HIV

Adults:

  • ART should be initiated in all adults living with HIV at any CD4 cell count (New)
  • As a priority, ART should be initiated in all adults with severe or advanced HIV clinical disease (WHO clinical stage 3 or 4) and individuals with CD4 count ≤350 cells/mm3

Pregnant and Breastfeeding women:

  • ART should be initiated in all pregnant and breastfeeding women living with HIV at any CD4 cell count and continued lifelong (Updated)

Adolescents (10-19 years old):

  • ART should be initiated in all adolescents living with HIV at any CD4 cell count (New)
  • As a priority, ART should be initiated in all adolescents with severe or advanced HIV clinical disease (WHO clinical stage 3 or 4) and individuals with CD4 count ≤350 cells/mm3

Children (1 to <10 years old):

  • ART should be initiated in all children 1 to <10 years old living with HIV at any CD4 cell count (New)
  • As a priority, ART should be initiated among all children <2 years old and those with severe or advanced HIV clinical disease (WHO clinical stage 3 or 4) and individuals with CD4% <25% (if <5 years old) or CD4 count ≤350 cells/ mm3 (if ≥5 years old)

Children <1 year old:

ART should be initiated in all children living with HIV younger than 1 year old at any CD4 cell count

2. Oral Pre-exposure Prophylaxis to prevent HIV acquisition

HIV-negative individuals at substantial risk of HIV infection (serodiscordant couples, Men who have sex with Men (MSM), Transgender women):

  • Oral PrEP (containing TDF) should be offered as an additional prevention choice for people at substantial risk of HIV infection as part of combination prevention approaches (New)

Useful Links:

Link to the WHO press release:

http://www.who.int/mediacentre/news/releases/2015/hiv-treat-all-recommendation/en/

Link to the Guideline document (English):

http://apps.who.int/iris/bitstream/10665/186275/1/9789241509565_eng.pdf?ua=1

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