In a widely anticipated move, the World Health Organization (WHO) today endorsed antiretroviral (ARV) treatment for all 37 million HIV-infected people around the world. Previous guidelines called for only treating the estimated 28 million HIV-infected people who have fewer than 500 CD4 lymphocytes per microliter of blood. (The normal range is 600 to 1200.) The new guidelines also call for offering the drugs to prevent HIV infection—so-called pre-exposure prophylaxis, or PrEP—to all people at “substantial risk” of infection.
Currently, only 15 million HIV-infected people are receiving antiretrovirals. But in rich countries, it's becoming more and more common to start therapy early, before a patient's CD4 cells have had significant declines. Large studies have shown that early treatment benefits HIV-infected people and, separately, that ARVs dramatically reduce the risk of transmission. Several PrEP studies similarly have shown that ARVs protect uninfected people regardless of the route of transmission.
The Joint United Nations Programme on HIV/AIDS earlier called for a “fast-track” approach to end the world’s AIDS epidemic by 2030 that would increase the necessary annual investments—now at $21.7 billion—by $12 billion. The fast-track targets only call for 81% of HIV-infected people to be on ARVs by 2020. It remains a huge question mark whether the world will foot the bill for these ambitious goals. Doing so will require more domestic spending by low-income countries that are hardest hit by the epidemic as well as larger contributions from wealthy nations.
WHO dubbed the new recommendations an “early release guideline” and plans to release more complete revisions in 2016. WHO began releasing HIV treatment guidelines in 2002, at which point ARVs were recommended only for people who had fewer than 200 CD4s.