Treat AIDS earlier and prevent with antiretrovirals: these are the two main orientations of the WHO recommendations on the use of triple therapy.
Treat everyone, right away. The World Health Organization (WHO) wants to expand the prescription of antiretroviral treatments. In his new recommendations, the UN health agency takes into account the latest developments in the treatment of HIV … A decision eagerly awaited by the medical community.
Antiretrovirals for all
“Anyone infected with HIV should start antiretroviral therapy as soon as possible after diagnosis. From now on, HIV-positive people will be able to benefit from treatment even before the virus has attacked their immune defenses. Until now, the WHO recommended starting the triple therapy when the concentration of CD4 + T lymphocytes was low (less than 500 cells / mm3). A dated position that many developed countries no longer followed, including France.
The results of the American (START) and French (Temprano) tests finally convinced the Organization’s executives. It must be said that the impact on opportunistic infections is considerable: not only does this strategy reduce serious AIDS-related events by 72%, but it also makes it possible to reduce diseases that are not associated with it (-44%) .
PrEP for those at risk
The other good news is that the WHO is also expanding the conditions for access to pre-exposure prophylaxis (PrEP), as demanded by experts in the field. Anyone at “substantial” risk of contamination should have access to Truvada. “PrEP must be considered as a possibility of complementary prevention, based on a set of services such as HIV testing, counseling and support, but also access to condoms and secure injection equipment” , however, points out the Organization.
“These recommendations come at an opportune time and will facilitate the access of the poorest and most vulnerable populations to the best treatments and services that modern science can offer, and they are already available in the richest countries”, welcomes Lelio Marmor, Managing Director of Unitaid. According to estimates by this organization, this update is expected to prevent 21 million AIDS-related deaths and 28 million new infections by 2030.
2030: a world without AIDS
“Expanding access to treatment is at the heart of the new goals for 2020, with the aim of ending the AIDS epidemic by 2030,” the WHO said in a statement. A target that includes 90% of seropositive people aware of their infection, 90% of those on antiretrovirals, and among this population, 90% of those whose viral load is no longer detectable. With these recommendations, a population of 37 million people will be able to access triple therapy.
But of course, access to antiretrovirals will not take place under all conditions. Each country must first ensure that screening and treatment are available to everyone, but above all that the patients treated are encouraged to comply and will not leave the healthcare system. This is the biggest difficulty.
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