Click on the cover to download full guidelines. (
Click on the cover to download full guidelines. (

Yesterday the World Health Organization said that treatment for people living with HIV should start when CD4 count is 500 per cubic millimetre or less. Previously, it was when the count was 350 or less.

The announcement came on the opening day of the International AIDS Society 2013 conference in Kuala Lumpur. The new recommendations are found in Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection.

The new recommendations encourage all countries to initiate treatment in adults living with HIV when their CD4 cell count falls to 500 cells/mm³ or less – when their immune systems are still strong. The previous WHO recommendation, set in 2010, was to offer treatment at 350 CD4 cells/mm³ or less. 90% of all countries have adopted the 2010 recommendation. A few, such as Algeria, Argentina and Brazil, are already offering treatment at 500 cells/mm3.

The new recommendations also include providing antiretroviral therapy – irrespective of their CD4 count – to all children with HIV under 5 years of age, all pregnant and breastfeeding women with HIV, and to all HIV-positive partners where one partner in the relationship is uninfected. The Organization continues to recommend that all people with HIV with active tuberculosis or with hepatitis B disease receive antiretroviral therapy.

Another new recommendation is to offer all adults starting to take ART the same daily single fixed-dose combination pill. This combination is easier to take and safer than alternative combinations previously recommended and can be used in adults, pregnant women, adolescents and older children.


The recommended treatment is now a combination of three antiretroviral drugs: tenofovir and lamivudine (or emtricitabine) and efavirenz, as a single pill, given once daily.

This policy will only work if people are tested regularly and so get diagnosed before their CD4 drops far below 500. When I was diagnosed my CD4 was 100 – so almost immediately I was put on to treatment. Many people living with HIV that I know are almost frightened by starting treatment, but the new drugs seem to have far fewer side effects. I suspect that by normalising starting treatment to nearly everyone, the WHO is making a great step towards breaking down the stigma that still surrounds those of us living with HIV.

Have you had an HIV test? If not (and you live in the UK), find your nearest HIV testing centre via nam aidsmap’s HIV test finder.

I hope the United Kingdom and Ireland health authorities make this change as soon as possible.

Further reading: