WHO releases a ‘treat-all’ recommendation for HIV patients At the end of September 2015, the WHO released a recommendation that, rather than waiting until CD4þ cell counts fall below a certain level, all people with HIV should get treated as soon as possible after diagnosis. By 2020, its goal is for 90% of people living with HIV to be aware of their infection, for 90% of those people to receive antiretroviral therapy (ART), and for 90% of people on ART to have no detectable virus in their blood. Dr Gitau Mburu of the International HIV/AIDS Alliance was involved in developing these guidelines. He says, ‘The 90/90/90 targets are extremely ambitious: we would need to have between 30 and 35 million people on treatment by 2020 to meet this goal, and that means more than double the number of people on treatment currently. What we have learnt is that global solidarity and the commitment of national governments can make largescale treatment possible’. ‘I commend the WHO and the global public health community for this recommendation’, says Mark Siedner of Harvard University. ‘For too long, we have had two sets of recommendations – those for the US and Europe, and those for the rest of the world’. Anat Rosenthal of BenGurion University agrees, ‘This is the way big things get done. Looking back at the 3 by 5 Initiative, it changed not only the actual number of people in low and middleincome countries who gained access to care, but also the way we address the idea of providing treatment. Ambitious goals are the way we move forward’. She notes that some countries in sub-Saharan Africa have already started adopting test-and-treat policies, such as Option Bþ, which is aimed at preventing mother-to-child transmission. Siedner warns, however, ‘The guidelines themselves cannot get us to 90/90/90. Our research partners and

others have recently demonstrated that average CD4þ cell counts for those initiating treatment in sub-Saharan Africa remain well below even prior recommended levels, with up to 50% of individuals starting ART at CD4þ cell counts less than 200 cells/ml. To really move the needle on HIV care and get to WHO and UNAIDS goals, we will need to redouble our efforts to identify infected persons earlier in the course of disease and address stigma and structural barriers to care, such as transportation and other secondary treatment costs’. Finding the money to pay for treatment consistent with these recommendations will certainly be a challenge. However, Siedner believes that working to reduce the costs of treatment and ancillary services combined with lower treatment costs when patients present earlier should help make these goals attainable. ‘As we begin to meet treatment goals, both per-patient treatment costs and HIV incidence should decrease and result in decreasing program costs’.

Acknowledgements Conflicts of interest There are no conflicts of interest. Kristin Nicole Harper Seattle, Washington, USA. Correspondence to Kristin Nicole Harper, PhD, Harper Health & Science Communications, LLC, Seattle, WA, USA. Tel: +1 314 550 5191; fax: +1 866 288 1541; E-mail: [email protected] Received 20 November 2015; accepted 3 December 2015

DOI:10.1097/QAD.0000000000001000

ISSN 0269-9370 Copyright Q 2016 Wolters Kluwer Health, Inc. All rights reserved.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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WHO releases a 'treat-all' recommendation for HIV patients.

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