The World Health Organization just released new guidelines for caring for people with HIV, recommending that anyone infected with the virus be treated with antiretroviral medications as soon as possible.
This removes any restrictions on eligibility for the drugs, which were previously recommended only for those whose immune system counts fell below a certain level. "All populations and age groups are now eligible for treatment," according to a WHO press release.
The global health agency also advised that people at "substantial" risk of HIV be offered a preventive antiretroviral treatment, known as PrEP, expanding their recommendation beyond the 2014 guidance that PrEP be used mainly by men who have sex with men.
"These new guidelines and recommendations are a highly significant moment in the AIDS response," said Michel Sidibé, executive director of UNAIDS. "The medicines and scientific tools now at our disposal provide us with a real opportunity to save millions of lives over the coming years and to end the AIDS epidemic by 2030."
According to the WHO, their guidance would expand the number of people eligible for antiretroviral treatment from 28 million to 37 million people.
The guidance for treatment follows clinical trials that found starting therapy early can cut the chances of transmission among the infected and extend the lives of people living with HIV.
The guidance on PrEP — for HIV-negative people who are at a substantial risk of acquiring the virus — also follows new evidence that these medications can be very effective at preventing the virus from spreading.
Earlier this month, a study in the journal Clinical Infectious Diseases examined how PrEP was used in San Francisco among men who have sex with men. Over three years, the researchers followed men who started using PrEP to see whether they contracted the virus. Not one of the 657 patients on the drug got HIV.
That echoes the results of the Ipergay study published earlier this year. Researchers looked at what would happen if people didn't take the drug daily but instead took it before and after they had sex. Even under these conditions, PrEP reduced HIV risk among men who have sex with men by an average of 86 percent. That's not quite as good as taking the drug every day, but it suggests that even imperfect use can be effective.
As a first step, the new guidelines also say that countries need to make sure that "testing and treatment for HIV infection are readily available and that those undergoing treatment are supported to adhere to recommended regimens and are retained in care."
How far countries can take the recommendations remains to be seen. Rick Elion, an HIV specialist and professor of medicine at George Washington University School of Medicine, wondered who will pay for all the extra therapies.
"These guidelines will highlight the disparity between what people should have and what they can afford. The developing world is barely meeting the current goals, and this expands on them quite a bit," he said. PrEP, for example, can cost about $13,000 a year in the US.
Still, Elion added that the guidelines are a step in the right direction. "It is important to make guidelines that are consistent with science," he said, "rather than commensurate with one's resources."