15 facts on HIV treatment scale-up and new WHO ARV guidelines 2013
1. At the end of 2012, 9.7 million people in low- and middle-income countries were on antiretroviral treatment (ART). The number of people on ART increased by 1.6 million in 2012, the biggest increase in one year to date (as reported in "Global update on HIV treatment 2013: results, impact and opportunities").
2. The provision of antiretrovirals for the prevention of mother-to-child transmission has increased to over 900 000 women in 2012.
3. Four out of five people newly put on treatment live in sub-Saharan Africa. In 21 African countries with a high burden of HIV (prioritized in the "Global plan to prevent mother-to-child transmission") two out of three people in need are receiving treatment, and two out of three positive pregnant women are receiving ARV drugs to prevent HIV transmission to their infants.
4. ART for children is also expanding, but less rapidly than for adults. In the Global Plan countries, only one out of three children in need of ART is receiving it. Globally, other key populations (men who have sex with men, sex workers and people who inject drugs) appear also have less access to ART.
5. Over the last decade, ART scale-up in low- and middle-income countries has saved an estimated 4.2 million lives, and prevented and estimated 800 000 child infections.
6. Globally, the number of AIDS related deaths decreased from 2.3 million in 2005 to 1.7 million in 2011. In countries with major ART scale-up (such as Brazil or China), the death rate among people living with HIV has decreased by 80%. In South Africa, life expectancy increased from 54 to 60 years between 2005 and 2011, largely due to ART scale-up.
7. ART also helps to prevent HIV transmission, and has contributed to the global decrease of 20% in the estimated number new infections between 2001 and 2011.
New consolidated guidelines
8. The WHO "Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection", for the first time, will bring together clinical, service delivery and programmatic guidance for low- and middle- income countries across all age ranges (adults, adolescents, children and pregnant women).
9. These guidelines recommend earlier treatment and raise the threshold for starting ARVs from a CD4 of 350 cells/mm3 to 500 cells/mm3 (i.e. starting treatment when the immune system is stronger) because of the evidence that earlier treatment prolongs life and results in fewer transmission from an infected person to an uninfected person.
10. These guidelines also recommend that all pregnant women start ART at any CD4 count and continue lifelong or until the risk of transmission of HIV to the infant has passed, and that all children under 5 years should start ART as soon as HIV is diagnosed.
11. These guidelines recommend a preferred first-line, fixed dosed combination of three ARV drugs in a single pill. This regimen of tenofovir + lamivudine (or emtricitabine) + efavirenz (TDF+3TC (or FTC)+EFV) was selected because it is simple, less toxic and can be used in all populations except for very young children. Children less than three years old should use a regimen including another drug called lopinavir/ritonavir (LPV/r).
12. Implementation of these clinical recommendations is supported by new recommendations to bring HIV care and treatment closer to the patient and into the community. These guidelines support even greater scale-up of HIV treatment and care programs so that the target of 15 million persons on HIV treatment by 2015 becomes a reality.
13. If the positive dynamic in scale-up can be maintained, the global target - set by member states of the United Nations - of providing ART to 15 million people on ART by the end of 2015 can be reached.
14. New WHO guidelines on the use of antiretroviral drugs for treating and preventing HIV infection will widen the circle of people eligible for ART to 26 million people in low- and middle- income countries.
15. Compared to current standards, the new guidelines can reduce the number of AIDS deaths and new HIV infections by an additional 36%-39% percent (in the year 2025).