New WHO guidelines support early treatment for HIV

The World Health Organization has launched new guidelines for the treatment and prevention of HIV which reflect conclusive evidence from studies conducted by leading HIV research organisations, including the Kirby Institute at UNSW Australia. Released at the WHO headquarters in Geneva, the guidelines signify a landmark change in the international response to HIV treatment and prevention. 

 

While the previous guidelines recommended waiting till people with HIV showed immune symptoms of the virus before starting treatment, the latest recommendation from the WHO is to “treat all” by initiating antiretroviral treatment (ART) as soon after diagnosis as possible. The new guidelines remove all limitations on eligibility for ART among people living with HIV making all populations and age groups eligible for treatment. 

 

Earlier this year the Strategic Timing of AntiRetroviral Treatment (START) trial, a study co-coordinated by Kirby Institute, was terminated ahead of schedule after interim results provided conclusive evidence that immediate treatment of HIV is clinically superior compared with deferred treatment among people with HIV infection and early disease. 

 

The guidelines recommending early initiation of treatment reflect findings from the START study that showed the risk of serious AIDS events and deaths due to non-AIDS events including major cardiovascular events, renal and liver disease and cancer was reduced by more than 50 per cent among those in the early treatment group compared to those in the deferred group.

 

 “We now know that treatment at all stages of the disease extends survival and prevents serious disease complications in people with HIV infection,” said Professor Sean Emery the co-ordinating investigator of the START study at the Kirby Institute. “Together with data from previous studies showing reduced risk of HIV transmission among people on ART, these findings support treatment for everyone with HIV.” 

 

The new WHO guidelines also recommend that access to PrEP is expanded beyond limited high risk population groups. PrEP, or Pre-Exposure Prophylaxis is a daily pill that reduces the risk of HIV negative people becoming infected with HIV. 

 

Dr Iryna Zablotska-Manos from the Kirby Institute is the chief investigator of the largest PrEP trial being conducted in Australia.  “While Australia already has national guidelines in place for the prescription of PrEP, this guideline is particularly important for low and middle income countries, where larger populations are at risk of HIV,” said Dr Zablotska-Manos. “With increased use and demand for PrEP the costs of prevention should come down – and this is good news for all countries, including Australia.”

 

UNAIDS estimate that expanding ART to all people living with HIV and expanding prevention choices could help avert 21 million AIDS-related deaths and 28 million new infections by 2030.