World Health Organization’s updated guidelines call for expansion of ART to save lives and prevent more infections

published on June 29, 2013

New HIV therapy guidelines to boost universal access to HIV treatment by 2015 and potentially avert 3 million AIDS-related deaths and 3.5 million new HIV infections between 2013 and 2025

Vancouver, B.C. [June 29, 2013] — The BC Centre for Excellence in HIV/AIDS (BC-CfE) today lauded the World Health Organization (WHO) for its new HIV therapy guidelines that are expected to expand eligibility to antiretroviral treatment (ART) to an estimated 26 million people globally by 2015. This compares to a target of 15 million people on treatment by 2015 based on the 2010 guidelines.

The updated guidelines were launched to coincide with the opening of the 7th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Kuala Lumpur, Malaysia from June 30 to July 3.

The key recommendation of the 2013 WHO guidelines was to initiate treatment sooner in order to save more lives and prevent more infections. According to the new guidelines, ART should be administered to all HIV-positive individuals with a CD4 cell count (cells of the immune system that are affected by HIV) of 500 cells/mm3 or less. Earlier guidelines indicated treatment initiation at a CD4 cell count of 350 cells/mm3. In addition, the 2013 WHO guidelines recommend that treatment be offered regardless of CD4 count level if there is TB co-infection, or liver disease due to Hepatitis B virus co-infection, or for individuals at very high risk for HIV transmission, such as those in sero-discordant couples and pregnant HIV infected women, who should be encouraged to start HAART during pregnancy and to continue it for life thereafter, and for children infected with HIV under the age of 5 years old.

“This is excellent news for people living with HIV,” said Dr. Julio Montaner, director of the BC-CfE. “There is clear evidence to show antiretroviral therapy not only dramatically reduces HIV/AIDS-related mortality and morbidity, but secondarily without any extra investment it prevents new HIV infections. I applaud WHO for embracing Treatment as Prevention to increase the number of people who can benefit from these life-saving drugs and help us move forward in achieving an HIV & AIDS-free generation.”

British Columbia is an internationally recognized leader for innovative HIV/AIDS research, including pioneering the Treatment as Prevention strategy, which calls for widespread access to antiretroviral drugs for all eligible HIV-positive individuals. As the only province in Canada to implement Treatment as Prevention, B.C. stands alone in demonstrating a consistent decline in new HIV diagnoses since 1996. In B.C., the number of individuals receiving treatment increased from 837 to more than 7,000 between 1996 and 2012, and, as a result, HIV-related morbidity and mortality have declined by approximately 90 per cent since the early 1990s. In addition, the number of new HIV diagnoses fell from approximately 800 per year prior to 1996 to 238 in 2012.

“We are pleased to launch these new guidelines to bring the proven benefits of earlier antiretroviral treatment to more HIV-positive individuals,” said Dr. Gottfried Hirnschall, director of the HIV Department of WHO. “Beyond earlier initiation of ART, there are also recommendations for simplified treatment by a single pill, once daily regimen, and improved monitoring for persons on ART. These new recommendations are a major step forward. Their successful implementation will require sustained commitment by countries, key funders, and implementation partners to achieve universal access to ART.”

WHO estimates that realizing the full potential of the updated guidelines will require an estimated 10 per cent increase to the total annual investment in the global HIV response. It will also require active and ongoing participation at the country level to implement, adapt, monitor, and evaluate the uptake of ART.

The new guidelines, titled Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection, consolidate existing and new clinical, operational and programmatic guidance on the strategic use of ARVs in different populations and settings. For the first time, the guidelines combine recommendations across the continuum of HIV care, including: HIV testing and counselling, using ARV drugs for HIV prevention, linking individuals to treatment and care, and initiating, maintaining, and monitoring treatment.

An advanced version of the guidelines was presented at the BC-CfE-hosted 2013 International HIV Treatment as Prevention Workshop in Vancouver in April this year.

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What is Treatment as Prevention?
The Treatment as Prevention strategy has been pioneered by BC-CfE’s Dr. Julio Montaner. It involves widespread HIV testing and immediate provision of anti-HIV drugs known as HAART to medically eligible people with HIV. The BC-CfE has demonstrated that the benefits of early HAART treatment are twofold: it reduces the level of HIV in the blood to undetectable levels thus improving the health of people with HIV, and decreases the level of HIV in sexual fluids to undetectable levels thus reducing the likelihood of HIV transmission by more than 95 per cent. In 2009, the BC government invested $48 million over four years in the BC-CfE-led Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) pilot project. The intent of the pilot is to expand HIV testing and treatment among hard-to-reach populations such as injection drug users in Vancouver’s inner city and Prince George.

Treatment as Prevention is internationally recognized by organizations such as the World Health Organization, International AIDS Society and the Joint United Nations Programme on HIV/AIDS (UNAIDS). Treatment as Prevention has been endorsed by U.S. President Barack Obama, Secretary of State Hillary Clinton and former U.S. President Bill Clinton as an effective strategy in the fight against HIV/AIDS.

About the British Columbia Centre for Excellence in HIV/AIDS
The BC Centre for Excellence in HIV/AIDS (BC-CfE) is Canada’s largest HIV/AIDS research, treatment and education facility and is internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases. BC-CfE is based at St. Paul’s Hospital, Providence Health Care, a teaching hospital of the University of British Columbia. The BC-CfE works in close collaboration with key provincial stakeholders, including health authorities, health care providers, academics from other institutions, and the community to decrease the health burden of HIV and AIDS and to improve the health of British Columbians living with HIV through developing, monitoring and disseminating comprehensive research and treatment programs for HIV and related illnesses.

About the University of British Columbia
The University of British Columbia (UBC) is one of North America’s largest public research and teaching institutions, and one of only two Canadian institutions consistently ranked among the world’s 40 best universities. Surrounded by the beauty of the Canadian West, it is a place that inspires bold, new ways of thinking that have helped make it a national leader in areas as diverse as community service learning, sustainability and research commercialization. UBC offers more than 55,000 students a range of innovative programs and attracts $550 million per year in research funding from government, non-profit organizations and industry through 7,000 grants.

For additional information or to request interviews, please contact:

Kevin Hollett
BC-CfE
Phone: 604-682-2344 ext. 66536
Mobile: 778-848-3420
Email: khollett@cfenet.ubc.ca

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World Health Organization’s updated guidelines call for expansion of ART to save lives and prevent more infections

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