The Centers for Disease Control and Prevention (CDC) says it welcomes the announcement by the World Health Organization (WHO) of new Early Release HIV Treatment and Pre-Exposure Prophylaxis (PrEP) guidelines that will significantly increase the number of people eligible for life-saving antiretroviral treatment (ART) and expand access to a powerful tool for preventing HIV among those at greatest risk.
These recommendations are a major step forward in the global fight against HIV. They have the potential to dramatically reduce transmission of HIV worldwide, increase the widespread use of PrEP among those who need it most, and help those living with HIV live longer, healthier lives.
The new WHO guidelines call for treatment for all individuals living with HIV – regardless of CD4 count. This is a dramatic shift from existing WHO guidelines that recommend ART for those with compromised immune systems (CD4 counts less than 500) and other vulnerable populations such as children, pregnant women, and people with TB. The new guidelines also recommend daily oral PrEP as an additional prevention choice for those at substantial risk for contracting HIV as part of a combination prevention approach.
Thanks to recent scientific breakthroughs, we now know unequivocally that early and effective treatment not only reduces HIV transmission but also significantly improves health outcomes for those living with HIV. The research on PrEP is also strong. PrEP has been shown in many studies and “real world” situations to reduce the risk of HIV infection by more than 90 percent among those who regularly take their medications.
While the science is clear, today’s guidelines are a call to policymakers and the public health community worldwide to translate that science into action. The WHO Early Release Guidelines support countries in expanding access to HIV treatment and affirm the promise of PrEP as an important part of a comprehensive response to HIV.
Today’s announcement aligns with two key U.S. recommendations. In 2012, the U.S. Department of Health and Human Services (HHS) issued treatment guidelines recommending ART for all patients diagnosed with HIV infection. In 2015, this was upgraded to an A1 recommendation, based on the highest quality evidence (a randomized controlled clinical trial). In 2014, the CDC issued first-ever clinical guidance recommending physicians consider advising the use of PrEP for gay and bisexual men, heterosexuals, and injection drug users at substantial risk for HIV infection.
In collaboration with other United States agencies and global partners, the CDC and the National Institutes of Health, both part of HHS, have been at the forefront of PrEP research efforts. The CDC also is helping to increase access to ART for those who need it around the world.