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Guideline on When to Start Antiretroviral Therapy and on Post-Exposure Prophylaxis for HIV

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Geneva, WHO, 2015

This early-release guideline makes available two key recommendations that were developed during the revision process in 2015. First, antiretroviral therapy (ART) should be initiated in everyone living with HIV at any CD4 cell count. Second, the use of daily oral pre-exposure prophylaxis (PrEP) is recommended as a prevention choice for people at substantial risk of HIV infection as part of combination prevention approaches. The first of these recommendations is based on evidence from clinical trials and observational studies released since 2013 showing that earlier use of ART results in better clinical outcomes for people living with HIV compared with delayed treatment. The second recommendation is based on clinical trial results confirming the efficacy of the ARV drug tenofovir for use as PrEP to prevent people from acquiring HIV in a wide variety of settings and populations.

The two recommendations are being made available on an early-release basis because of their potential to significantly reduce the number of people acquiring HIV infection and dying from HIV-related causes and significantly impact global public health. By publishing these recommendations as soon as possible, WHO aims to help countries to anticipate their implications in a timely fashion and begin the dialogue necessary to ensure that national standards of HIV prevention and treatment are keeping pace with important scientific developments.

The target audience for this guideline is primarily national HIV programme managers, who will be responsible for adapting the new recommendations at country level. The guideline will also be of interest to a wide range of other stakeholders, including national TB programme managers and civil society organizations, as well as domestic and international funders of HIV programmes.

The recommendations in this guideline will form part of the revised consolidated guidelines on the use of ARV drugs for treating and preventing HIV infection to be published by WHO in 2016. The full update of the guidelines will consist of comprehensive clinical recommendations together with revised operational and service delivery guidance to support implementation.