WHO released 2013 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treatment and Prevention today at the IAS 2013 conference in Kuala Lumpur, which can be downloaded here: Its key points, according to support materials:
- Treating adults, adolescents and older children earlier – starting ART in all individuals with a CD4 cell count of 500 cells/mm3 or less and giving priority to individuals with severe or advanced HIV disease and those with a CD4 cell count of 350 cells/mm3 or less;
- Starting ART at any CD4 count for certain populations with HIV, including people with active TB disease, people with hepatitis B virus (HBV) coinfection with severe chronic liver disease, HIV-positive partners in serodiscordant couples, pregnant and breastfeeding women and children younger than five years of age;
- A new, preferred first-line ART regimen harmonized for adults, pregnant and breastfeeding women and children aged three years and older [tenofovir/3TC or FTC/efavirenz];
- Support to actively accelerate the phasing out of stavudine (d4T) in first-line ART regimens for adults and adolescents;
- The use of viral load testing as the preferred approach to monitoring the success of ART and diagnosing treatment failure in addition to clinical and CD4 monitoring of people receiving ART; and
- Community-based HIV testing and counselling and HIV testing of adolescents to diagnose people with HIV earlier and link them to care and treatment.
As the guidelines admit, different countries have differing capacity to rise to the challenge of expanding treatment at this time, and so the guidelines also provide operational guidance on how to expand the scale-up of ART, and programmatic guidance to assist programme managers plan implementation in their context.