Foreword by WHO Director-General Dr Margaret Chan
With this publication, WHO issues its first consolidated guidelines for the use of antiretroviral drugs to treat and prevent HIV infection. The guidelines are ambitious in their expected impact, yet simplified in their approach, and firmly rooted in evidence. They take advantage of several recent trends, including a preferred treatment regimen that has been simplified to a single fixed-dose combination pill taken once per day, which is safer and affordable.
The guidelines also take advantage of evidence demonstrating the multiple benefits of antiretroviral therapy. With the right therapy, started at the right time, people with HIV can now expect to live long and healthy lives. They are also able to protect their sexual partners and infants as the risk of transmitting the virus is greatly reduced.
The guidelines represent another leap ahead in a trend of ever-higher goals and evergreater achievements. In Africa, the region that bears the brunt of the HIV epidemic, an estimated 7.5 million people were receiving treatment at the end of 2012, compared with only 50,000 a decade earlier. Worldwide, some 9.7 million people were receiving treatment, indicating that the global target of providing antiretroviral therapy to 15 million people by 2015 is within reach. The present achievement represents the fastest scale-up of a life-saving public health intervention in history.
A key way to accelerate progress is to start treatment earlier, as recommended in the guidelines. As the evidence now shows, earlier treatment brings the dual advantage of keeping people healthier longer and dramatically reducing the risk of virus transmission to others.
Earlier treatment has the further advantage of simplifying the operational demands on programmes. The guidelines recommend that pregnant women and children under the age of five years start treatment immediately after diagnosis. The same once-per-day combination pill is now recommended for all adults living with HIV, including those with tuberculosis, hepatitis, and other co-infections.
Additional recommendations in the guidelines aim to help programmes get services closer to people’s homes; expedite test results; integrate HIV treatment more closely with antenatal, tuberculosis, drug dependence and other services; and use a wider range of health workers to administer treatment and follow-up care.
Countries asked WHO for simplified guidance on the use of antiretroviral drugs. I believe these consolidated guidelines go a long way towards meeting that request. They offer recommendations for all age groups and populations. They bring clinical recommendations together with operational and programmatic guidance on critical dimensions of treatment and care, from testing through enrollment and retention, and from general HIV care to the management of co-morbidities.
The new guidelines ask programmes to make some significant changes. They also require increased investments. I am personally convinced that the future of the HIV response will follow the pattern of the recent past: that is, a constant willingness to build on success and rise to new challenges.
WHO estimates that doing so will have an unprecedented impact: global implementation of the guidelines could avert an additional 3 million deaths between now and 2025, over and above those averted using 2010 guidelines, and prevent around 3.5 million new infections.
Such prospects – unthinkable just a few years ago – can now fuel the momentum needed to push the HIV epidemic into irreversible decline. I strongly encourage countries and their development partners to seize this unparalleled opportunity that takes us one more leap ahead.
Dr Margaret Chan