There has been new momentum at the highest political levels to put plans into place that will make the most use of the recent science showing ART itself both saves lives and stops HIV from spreading. International funding, however, remains largely stagnant across the board and will need to be increased to achieve the goals of saving more lives through treatment, while dramatically reducing HIV transmission.
In its 2013 consolidated HIV treatment guidelines, the World Health Organization (WHO) is recommending a number of changes that will improve treatment in developing countries, first and foremost earlier initiation of treatment at a threshold of CD4 cell count of 500 or below. The new guidelines also recommend ART for life for all pregnant women with HIV (‘Option B+’) in countries with generalised epidemics, and as an option for all countries, as well as immediate treatment for HIV-positive individuals with HIV-negative partners (‘sero-discordant’ couples).
These recommendations increase considerably the number of people on treatment, with WHO estimating in 2012 that around 25 million people could be in need. 3 WHO also recommends routine viral load monitoring in order to detect and correct adherence problems as they arise, or switch people to alternative treatment if necessary. Further, tenofovir (TDF) is the clear preferred first-line regimen for adults, while treatment recommendations for children are simplified and strengthened, with ART recommended for all HIV-positive children under five years of age, and a boosted protease inhibitor recommended for all children under three.