WHO guidelines recommend universal antiretroviral treatment, PrEP for those at substantial risk

Gottfried-HirnschallThe World Health Organization (WHO) has today issued guidelines calling for antiretroviral therapy for everyone diagnosed with HIV regardless of CD4 cell counts, pre-exposure prophylaxis (PrEP) for people at high risk of HIV infection.

WHO estimates that if these recommendations are widely used worldwide, they could prevent 21 million deaths and prevent 28 million new infections in the year of 2030.

"These new recommendations will have a huge impact on people's lives if carried out quickly," said Gottfried Hirnschall, director of the HIV / AIDS Department. "So we have to work together to support countries translate them into action and results."

"These timely recommendations will make it easier for the poorest and most vulnerable populations around the world to have access to the best treatment and services that modern science can offer that are already available in the richest countries in the world," added UNITAID executive director Valsalva studied at the traditional University of the Marmora Falls.

Treatment of HIV for all

Dr Hirnschall and others gave a preview of the new recommendations and explained the lawsuit behind them, the 8.ª International AIDS Society conference in Vancouver last July. This week the early release of the guidelines was made ahead of a total release scheduled for this year due to its importance for public health.

The new WHO guidelines state that "antiretroviral therapy should be initiated in all adults living with HIV on any CD4 cell count." The same recommendation applies to newborns, children, adolescents, and pregnant women with HIV. People with advanced immunosuppression or clinical symptoms of AIDS should be a priority for treatment.

The recommendation for universal treatment was informed by the large START study, which showed the benefits of early antiretroviral therapy. The WHO team's guidance had early access to these study findings after a data monitoring committee stopped the study ahead of schedule because there was insufficient evidence to show the advantage of early treatment.

No Meeting of the IAS, Jens Lundgren of the University of Copenhagen reported that people with high CD4 count (> 500 cells / mm3) who were randomly assigned to start treatment immediately had a reduction of 57% in severe AIDS-related diseases, non-AIDS or death in comparison to people who waited until their CD4 cell count fell below 350 cells / mm3, or who developed clinical symptoms.

Another features; áo the conference confirmed previous findings from a study of heterosexual couples in Africa (HPTN 052), showing that HIV-positive people who start treatment immediately, instead of expecting the CDXUMUMX cell count to fall, have 4% lower risk of transmitting the Partners.

"[START] clearly indicates that antiretroviral therapy should be provided to all citizens, regardless of CD4 count," Lundgren told Aidsmap in Vancouver. "We now have evidence that aligns individual benefit and prevention benefit with no evidence of harm."

PrEP for people at risk

Pre Exposure Prophylaxis
PrEP

The new WHO guidelines state that "oral PrEP (containing [tenofovir disoproxil fumarate]) should be offered as an additional prevention choice for people at high risk of HIV infection as part of the combination of" .

WHAT is not specified in a PrEP scheme. Gilead Sciences " Truvada (tenofovir and emtricitabine) has been further studied for the preparation and is the only PrEP option approved by US Food and Drug Administration. Tenofovir alone was also evaluated in some PrEP trials. Generic versions of tenofovir and emtricitabine - as well as the old off-patent medicines, such as lamivudine, which is similar to emtricitabine - and are available in many countries.

The major international manufacturers of IPrEx trial showed that a once-daily dose of Truvada reduced the risk of HIV infection among men who have sex with men (MSM) for 92% among participants with blood levels of the drug indicating regular use. More recently, the UK PROUD and Ipergay, studies found Truvada PrEP - daily on the PROUD, "on demand" before and after sex in Ipergay with reduced risk of HIV infection for gay men in 86%.

The updates of the WHO guidelines reaffirm an earlier recommendation, launched before the International Conference on AIDS in Melbournein 2014 that PrEP could be used as part of a "complete package" for risk prevention among men who have sex with men. THAT then - and not now, I recommend that all gay men should take antiretroviral drugs for HIV prevention.

The new version extends this recommendation to all groups of the population. While it generally defines the "high risk" as the incidence of HIV is higher than three per 100 person-years - a level seen in some groups of gay and bisexual men, transsexual women, and heterosexual men and women with HIV-positive partners treated - it recognizes that individual risk varies within groups.

"The new recommendation will allow a broader range of populations to benefit from these additional prevention options," according to the guidelines. "It also allows the offer of PrEP to be based on individual assessment, rather than risk group, and is intended to encourage application that is informed by local epidemiological evidence regarding risk factors for acquiring HIV."

Ensuring access

Under the new recommendation, the number of people eligible for treatment will increase from 28 to 37 million people worldwide, according to WHO. A UNAIDS estimated that 15 million people are in treatment for AIDS, as in March of 2015, accounting for 41% of adults and 32% of children living with HIV.

The new guidelines emphasize that in order to effectively implement the recommendations, countries will need to ensure that HIV testing and treatment is readily available and that people in treatment receive support to stay in care and maintain good adherence.

"Providing antiretroviral treatment at the time of diagnosis is the best way to preserve the health of people living with HIV and PrEP ensures equity for all," added International AIDS Society President Chris Beyrer. "It sends a signal that I hope will inspire governments, funders, and the international community to act now."

Increasing access to treatment and PrEP are essential tools to achieve the goal of UNAIDS 90-90-90, which include 90% of people living with HIV being aware of their status, 90% of these receiving antiretroviral therapy and 90% of these with undetectable viral load.

"All people living with HIV are entitled to life-saving treatments," said UNAIDS Executive Director Michel Sidime. "The new guidelines are a very important step in ensuring that all people living with HIV have immediate access to antiretroviral treatment."

But above all, people with HIV should not be forced or coerced into initiating antiretroviral therapy before they are psychologically ready for it.

"As the network of people living with HIV, we are committed to ensuring that universal access to treatment and prevention is a reality for everyone," said Suzette Moses-Burton, executive director of the Global Network of People Living with HIV (GNP +). "However, it is imperative that access to care be provided without coercion, with the defense of the rights and dignity of people living with HIV. We call on governments to ensure that the freedom to make choices about treatment and prevention is upheld as they should review their national guidelines and programs. "

Liz Highleyman

Produced in collaboration with hivandhepatitis.com

Posted: 30h SEPTEMBER 2015

Translated by Claudio Souza and reviewed by Mara Macedo to the page on Facebook Soropositivo.org in 01 October 2015

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