Eligibility Criteria for Antiretroviral Therapy Expanded: World Health Organization Aims for a Better Future for People Living with HIV

Dear Editor,

Globally, over the last three decades, human immunodeficiency virus (HIV) has been a major public health concern [1]. HIV has achieved this status not only because of the number of infected patients (almost 37 million people are living with HIV), but also owing to stigma attributed to the disease and associated morbidity/mortality [1,2]. In fact, since its emergence, HIV has claimed more than 34 million lives worldwide [1]. The above estimates clearly suggest that the policy makers, administrators, health professionals, and other stakeholders need to do more  than the availability of rapid diagnostic kits and preventive measures including anti-retroviral treatment (ART) [1]. From the global perspective, only 40% of the people living with HIV are on ART, which indicates a major gap between the health system and those who actually need care and support [1,3]. The World Health Organization (WHO) has made two major recommendations to minimize the burden of the disease and its associated consequences in the coming years [4]. First, any person of any age who is diagnosed with HIV infection should be immediately started on ART irrespective of CD4 count [4]. This recommendation is based on the evidence summarized in systematic reviews that any untreated HIV infection is associated with dysfunction of different body organs and systems, and that early initiation of ART can significantly improve survival, and minimize the risk of transmission of the virus to their partners [3]. Second, prophylactic ART is recommended for uninfected people who are at high risk of acquiring HIV infection [5]. This recommendation is based on the efficacy of the drug tenofovir for pre-exposure prophylaxis (PrEP) in heterogeneous settings and covering different groups of population [4]. However, this PrEP should only be considered as an additional preventive measure to other existing measures (awareness, counselling, and support, access to condoms/safe injection needles, etc.) [4,5]. We believe that these two recommendations, if fully implemented, will help in controlling the HIV epidemic.

1. World Health Organization. HIV/AIDS – Fact sheet N°360; 2015. Available from: http://www.who.int/mediacentre/factsheets/fs360/en/ [Last accessed on 2016 Jan 13].
2. Ganju SA, Kanga AK, Bhagra S, Guleria RC, Singh DV, Agnihotri V, et al. Service delivery through public health care system to control sexually transmitted infections in Himachal Pradesh. Indian Dermatol Online J. 2014;5 (3):271-5.
3. The Antiretroviral Therapy Cohort Collaboration. Causes of death in HIV-1 infected patients treated with antiretroviral therapy, 1996–2006: collaborative analysis of 13 HIV cohort studies. Clin Infect Dis. 2010;50 (10):1387-96.
4. World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: WHO press; 2015. p. 1-7.
5. Haregu T, Oldenburg B, Sestwe G, Elliott J, Nanayakkara V. Epidemiology of comorbidity of HIV/AIDS and non-communicable diseases in developing countries: a systematic review. J Glob Health Care Syst. 2012;2 (1):142.
6. World Health Organization. Treat all people living with HIV, offer antiretrovirals as additional prevention choice for people at “substantial” risk; 2015. Available from: http://who.int/mediacentre/news/releases/2015/hiv-treat-all-recommendation/en/ [Last accessed on 2016 Jan 13].