Scientific evidence is driving the expansion of HIV treatment, with new guidelines from the World Health Organization (WHO) in 2013 nearly doubling the number of people eligible.
Countries are now being urged to implement the 2013 WHO HIV treatment guidelines by raising the threshold for treatment initiation from a CD4 count of 350 μ/mL to 500 μ/mL.
The WHO guidelines also recommended treatment initiation regardless of CD4 count for certain populations, including pregnant women, children under five, HIV-positive partners in serodiscordant couples, and people with HIV-associated tuberculosis or Hepatitis B.
In setting new treatment guidelines, the WHO recognized new evidence about the benefits of starting HIV treatment earlier. The HPTN 052 trial, for example, found that earlier treatment initiation is associated with improved health outcomes for people living with HIV, as well as a substantial reduction in the risk of further HIV transmission. According to modeling, scaling up towards 95% HIV treatment coverage by 2020 would dramatically reduce the annual number of AIDS-related deaths by more than two-thirds (see Fig. 1).
The move to revise treatment targets also aligns with an intensifying focus on the post-2015 development agenda. Although the world is currently on track to meet the 2015 target of 15 million people on HIV treatment, that is now projected to leave about half of all people eligible in 2015 without antiretroviral therapy.
In December 2013, the UNAIDS Programme Coordinating Board (PCB) encouraged national governments to revise their targets for universal HIV treatment and called on the Secretariat to support new target-setting processes. This month, HIV treatment experts will gather in Geneva to agree on concrete steps to assist countries in revising their targets. Although scaled-up HIV treatment is vital to ending the AIDS epidemic, it will need to be part of a comprehensive response. Treatment scale-up should be complemented and bolstered by sustained investments in other HIV prevention strategies and capacity-building for health and community systems. Barriers to treatment scale-up must be addressed and persistent deficits in treatment coverage, including for children and key populations, need to be closed.
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Julio Montaner, Pioneering Treatment as Prevention
In the global push for universal HIV treatment access, Dr. Julio Montaner is notable for his passion and commitment to STOP HIV/ AIDS. A past president of the International AIDS Society, Dr. Montaner directs the British Columbia Centre for Excellence in HIV/ AIDS in Vancouver, Canada. Dr. Montaner is a pioneer of using antiretroviral treatment to prevent HIV-related illness, AIDS-related deaths and HIV transmission.After British Columbia began rolling out Highly Active Antiretroviral Therapy in the mid-1990s, AIDS-related deaths plunged. In addition, Dr. Montaner and his colleagues noticed that although syphilis rates steadily increased, new HIV infections almost halved between 1995 and 1999.
Extensive research led Dr. Montaner and his colleagues to conclude that, in addition to dramatically lowering AIDS-related illness and death, scaled-up HIV treatment also enhanced efforts to prevent new HIV infections.
In January 2014, Dr. Montaner presented his latest findings in Geneva, indicating that infections averted by HIV treatment are maximized when therapy is initiated early in the course of infection and when coverage is rapidly increased.