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WHO Calls for Earlier HIV Treatment

Group issues new recommendations (June 30)

New guidelines for the treatment of human immunodeficiency virus (HIV) infection from the World Health Organization (WHO) recommend offering antiretroviral therapy (ART) earlier. According to the organization, recent evidence indicates that earlier ART will help people with HIV to live longer, healthier lives, and to reduce substantially the risk of transmitting HIV to others. The move could avert an additional 3 million deaths and prevent 3.5 million more new HIV infections between now and 2025, the WHO says.

The new recommendations encourage all countries to initiate treatment in HIV-infected adults when their CD4 cell count falls to 500 cells/mm3 or less — when their immune systems are still strong. The previous WHO recommendation, issued in 2010, was to offer treatment at 350 CD4 cells/mm3 or less. Ninety percent of all countries have adopted the 2010 recommendation. A few, such as Algeria, Argentina, and Brazil, are already offering treatment at 500 cells/mm3.

The new recommendations also include providing antiretroviral therapy — irrespective of their CD4 count — to all children with HIV under 5 years of age, to all pregnant and breastfeeding women with HIV, and to all HIV-positive partners where one partner in the relationship is uninfected. The WHO continues to recommend that all people with HIV with active tuberculosis or with hepatitis B disease receive antiretroviral therapy.

Another new recommendation is to offer all adults starting to take ART the same daily single fixed-dose combination pill. This combination is easier to take and safer than alternative combinations previously recommended and can be used in adults, pregnant women, adolescents, and older children.

The WHO is further encouraging countries to enhance the ways they deliver HIV services — for example, by linking them more closely with other health services, such as those for tuberculosis, maternal and child health, sexual and reproductive health, and treatment for drug dependence.

Source: WHO; June 30, 2013.

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