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WHO guidelines recommend universal antiretroviral treatment, PrEP to those who are at substantial risk

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

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

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

"These timely recommendations will make it easier for the poorest and most vulnerable populations around the world, having access to better treatment and services that modern science can offer, which are already available in the richer countries of the world" added UNITAID Executive Director Valsalva studied at the University of traditional Marmora Falls.

HIV treatment for all

Dr Hirnschall and others gave a preview of the new recommendations and explained the process behind them, the 8.ª International AIDS Society Conference in Vancouver last July. This week the anticipated release of the guidelines was made ahead of a full release expected later this year, because of its importance to public health.

The new WHO guidelines state that "antiretroviral therapy should be started in all adults living with HIV in 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 universal treatment recommendation was informed by large START study, which showed the benefits of early antiretroviral therapy. The WHO team guidelines had early access to the findings of the study after a data monitoring committee stopped the study ahead of schedule because there was insufficient evidence to show early treatment advantage.

No Meeting of the IASJens Lundgren of the University of Copenhagen reported that people with high score CD4 (> 500 cells / mm3) who were randomly assigned to start treatment immediately decreased by 57% in severe diseases related to AIDS, non-AIDS or death compared with those who have waited until its CD4 cell count falls below 350 cells / mm3 or that developed clinical symptoms.

Another features; áo the conference confirmed the previous results of a study of heterosexual couples in Africa (HPTN 052), showing that HIV-positive people who start treatment immediately instead of waiting for the fall of CD4 cell count, have 93% lower risk of transmitting HIV to their partners.

"[START] clearly indicates that antiretroviral therapy should be provided to all citizens regardless of CD4 count," said Lundgren to Aidsmapin Vancouver. "We now have evidence that aligns individual benefit and preventing benefit without evidence of harm."

PrEP for people at risk

Pre Exposure Prophylaxis

PrEP

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

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

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

Updates WHO guidelines reaffirm an earlier recommendation,released ahead of the International AIDS Conference in MelbourneIn 2014, that PrEP could be used as part of a "complete package" for risk prevention among men who have sex with men. WHAT then - not now recommend that all gays should take antiretroviral drugs for HIV prevention.

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

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

Ensuring access

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

The new guidelines stress that in order to effectively implement the recommendations, countries will have to ensure that testing and treatment for HIV are readily available and that people in treatment are supported to remain in the care and keeping a good grip.

"Providing antiretroviral therapy at diagnosis is the best way to preserve the health of people living with HIV, and PrEP ensures fairness for all," added the president of the International AIDS Society Chris Beyrer. "This sends a signal that I hope will inspire governments, donors, and the international community to act now."

Expand access to treatment and PrEP are essential tools for achieving the goal of UNAIDS 90-90-90, including 90% of people living with HIV being aware of their status, 90% of those receiving antiretroviral therapy and 90% of those with undetectable viral load.

"All people living with HIV are entitled to life-saving treatments," said the executive director of UNAIDS executive director Michel Sidimé. "The new guidelines are an important step to ensure that all people living with HIV have immediate access to antiretroviral treatment."

But above all, that people with HIV should not be forced or coerced to start antiretroviral therapy before it is ready psychologically for this.

"As the network of people living with HIV, we are committed to ensuring that universal access to treatment and prevention is a reality for all," said the executive director of the Global Network of People Living with HIV (GNP +) Suzette Moses-Burton. "However, it is imperative that access to care is offered without coercion, to defend 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 will be protected as they should review their national guidelines and programs. "

Liz Highleyman

Produced in collaboration with hivandhepatitis.com

Published: 30h 2015 SEPTEMBER

Translated by Claudio Souza and reviewed by Mara Macedoto the Facebook page Soropositivo.orgin October 01 2015

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