Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV

In 2013, WHO published the first consolidated guidelines on the use of antiretroviral (ARV)
drugs for HIV treatment and prevention across all age groups and populations. A comprehensive
revision of these guidelines based on new scientific evidence and lessons from implementation is
being undertaken in 2015.
This early-release guideline makes available two key recommendations that were developed
during the revision process in 2015. First, antiretroviral therapy (ART) should be initiated in
everyone living with HIV at any CD4 cell count. Second, the use of daily oral pre-exposure
prophylaxis (PrEP) is recommended as a prevention choice for people at substantial risk of HIV
infection as part of combination prevention approaches. The first of these recommendations is
based on evidence from clinical trials and observational studies released since 2013 showing that
earlier use of ART results in better clinical outcomes for people living with HIV compared with
delayed treatment. The second recommendation is based on clinical trial results confirming the
efficacy of the ARV drug tenofovir for use as PrEP to prevent people from acquiring HIV in a wide
variety of settings and populations.
The two recommendations are being made available on an early-release basis because of
their potential to significantly reduce the number of people acquiring HIV infection and dying
from HIV-related causes and significantly impact global public health. By publishing these
recommendations as soon as possible, WHO aims to help countries to anticipate their implications
in a timely fashion and begin the dialogue necessary to ensure that national standards of HIV
prevention and treatment are keeping pace with important scientific developments.
The target audience for this guideline is primarily national HIV programme managers, who will be
responsible for adapting the new recommendations at country level. The guideline will also be of
interest to a wide range of other stakeholders, including national TB programme managers and
civil society organizations, as well as domestic and international funders of HIV programmes.
The recommendations in this guideline will form part of the revised consolidated guidelines on
the use of ARV drugs for treating and preventing HIV infection to be published by WHO in 2016.
The full update of the guidelines will consist of comprehensive clinical recommendations together
with revised operational and service delivery guidance to support implementation.
A Clinical Guideline Development Group convened by WHO developed the recommendations in
this guideline based on systematic reviews that summarized the evidence available up to June
2015. The GRADE approach was used to determine the quality of the evidence and the strength
of the recommendation.
The ambitious UNAIDS Fast-Track targets for 2020, including achieving major reductions in
HIV-related mortality and new HIV infections and the 90–90–90 targets, will require countries
to further accelerate their HIV responses in the coming years. Much greater effort is also needed
to ensure that key and vulnerable populations and adolescents gain access to essential HIV
treatment and prevention services. Implementation of the recommendations in this guideline will
contribute to achieving these goals and to ultimately ending the AIDS epidemic as a major public
health threat by 2030.
Authors:WHO
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THESE GUIDELINES ARE WHO RECOMMENDATIONS AND  YET TO BE ADOPTED IN TANZANIA