Intended for healthcare professionals


All patients with HIV should get access to drug treatments regardless of CD4 count, says WHO

BMJ 2015; 351 doi: (Published 01 October 2015) Cite this as: BMJ 2015;351:h5239
  1. Anne Gulland
  1. 1London

All people with HIV, regardless of their blood cell count, should have immediate access to antiretroviral (ARV) therapies, a new guideline from the World Health Organization has stated.1

All populations and age groups are now recommended to have ARV drugs prescribed immediately after testing positive for the disease. In an early release guideline, WHO said that the expanded use of ARV treatment was supported by recent findings from clinical trials confirming that the early use of ARV therapy helps people with HIV to survive and be healthier and reduces their risk of transmitting the virus to a partner.

Previous guidelines in 2013 said that ARV drugs should be given only to people whose CD4 cell count fell to 500 cells/mm3 or lower.

WHO recommended that people at “substantial” risk of contracting HIV—for example, men who have sex with men, or people whose partners are HIV positive—should also be given the drug tenofovir as a preventive measure, known as pre-exposure prophylaxis.

The new recommendations will increase the number of people eligible for ARV therapy from 28 million to 37 million—the number estimated to have HIV globally. Estimates by the UNAIDS campaign group have shown that expanding treatment to all people with HIV would avert 21 million deaths and 28 million infections by 2030. WHO said that the cost implications of the guideline would vary from country to country and “should be further explored.”

The charity Médecins Sans Frontières welcomed the new guideline but said that greater investment was needed. Tom Ellman, director of the organisation’s Southern Africa Medical Unit, said, “At the United Nations last week, world leaders agreed to a sustainable development goal to make AIDS history within 15 years, but they are going to need to show that they’re serious about it. Nobody’s going to end AIDS with business as usual.”


Cite this as: BMJ 2015;351:h5239


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