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WHO HIV guidelines updated in the light of START and PROUD results

30 September 2015

The World Health Organisation (WHO) have today released updated guidelines that make recommendations based on the results of the START and PROUD studies. They say the new policies could help avert more than 21 million deaths and 28 million new infections by 2030.

The first new recommendation is that all people living with HIV should begin HIV treatment as soon after diagnosis as possible, without waiting for their immune system to weaken or symptoms appear. This recommendation is based, in part, on the results of the START trial, which was published in July this year. START found that starting HIV treatment straight away reduces the risk of people developing serious illnesses. Other studies have shown that starting treatment earlier also reduces the risk of passing the virus on to others.

The second new recommendation is that the offer of pre-exposure prophylaxis should be expanded to ‘people who are at substantial risk of becoming infected with HIV’. Pre-exposure prophylaxis (PrEP) is a HIV prevention strategy that involves HIV-negative people taking antiretroviral drugs to reduce the risk of becoming infected if they are exposed to the virus. A number of trials have shown that PrEP reduces HIV infections, including the PROUD study which was carried out in the UK, and published a few weeks ago.

The WHO guidelines are highly influential, with many national HIV programmes around the world basing their policies on the WHO recommendations. The full version of the updated WHO guidelines is due to be released later this year, but these two recommendations have been shared as ‘early release guidance’ because of their potential for public health impact.