Frequently Asked Questions: The World Health Organization’s 2013 HIV/AIDS Treatment Guidelines
With the release of comprehensive HIV/AIDS treatment guidelines from the World Health Organization (WHO) for 2013, we asked Dr. Christian Pitter, Senior Director of Global Technical Policy and Partnerships at the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), to answer some frequently asked questions about the guidelines and what they mean for the global effort to eliminate pediatric HIV.
When did the WHO launch the new guidelines?
The 2013 WHO Guidelines, titled The Consolidated Guidelines on the use of Antiretroviral Drugs for Treating and Preventing HIV Infection, were officially launched at the 2013 International AIDS Society Conference in Kuala Lumpur on June 30, 2013.
How are these guidelines different from the 2010 WHO treatment guidelines?
For the first time, the 2013 guidelines combine recommendations across the continuum of HIV care and prevention programs, including expanding treatment eligibility for HIV-positive pregnant women, mothers, and children.
How do these new guidelines impact people living with HIV in low- and middle-income countries?
Globally, an estimated 26 million people living with HIV in low-and middle-income countries will be eligible for antiretroviral therapy (ART) under the new guidelines, compared with the previous 17 million eligible recipients in accordance with the WHO’s 2010 guidelines. Full implementation could avert as many as 3 million AIDS-related deaths and 3.5 million new HIV infections between 2013 and 2025.
How do the new guidelines impact prevention of mother-to-child transmission (PMTCT) services?
The guidelines include recommendations to provide lifelong antiretroviral therapy (ART) for all HIV-positive pregnant and breastfeeding women in order to prevent mother-to-child transmission (PMTCT) of HIV. According to the WHO, providing lifelong ART for all HIV-positive pregnant and breastfeeding women, also known as Option B+, will boost PMTCT services and increase the likelihood that infants born to HIV-positive mothers will be born HIV-negative. In addition, lifelong ART may significantly improve the health and livelihood of HIV-positive pregnant women and mothers and prevent the spread of infection to their partners.
What are Option B+, Option B, and Option A?
Option A, Option B, and Option B+ are all approaches for utilizing antiretroviral medicines (ARVs) to prevent mother-to-child transmission of HIV, also called perinatal or vertical transmission, which occurs when HIV is transmitted from an HIV-positive woman to her baby during pregnancy, labor and delivery, or breastfeeding.
What is the difference between Option B and Option B+?
Under Option B+, there is a commitment to provide lifelong ART for life for all HIV-positive pregnant and breastfeeding women, regardless of CD4 count. During pregnancy and for the duration of the breastfeeding period, Options B and B+ are essentially the same. However, under Option B only women with low CD4 counts or advanced disease are eligible to receive lifelong ART. Women with higher CD4 counts take medication from 14 weeks of pregnancy only through childbirth (non-breastfeeding) or until one week after all breastfeeding has finished. ART would be restarted when a woman either becomes pregnant again or she meets the criteria for initiating treatment for her own health.
What is a CD4 count?
CD4 cells, also referred to as T-helper cells, are a type of white blood cell that fights infection. The CD4 count is a measure of the strength of the immune system and helps indicate the stage of HIV disease. As HIV infection progresses, the CD4 count declines – indicating declining immune status, increased potential for transmission of HIV to others, and increased susceptibility to opportunistic infections and death.
What are the new PMTCT recommendations officially named?
In the 2013 WHO antiretroviral (ARV) guidelines, several terminology changes were introduced in line with the revised guidelines, including moving away from Option “B” and “B+” to “providing lifelong antiretroviral therapy (ART) to all pregnant and breastfeeding women living with HIV regardless of CD4 count or clinical stage” or “providing ART for pregnant and breastfeeding women with HIV during the mother-to-child transmission risk period and then continuing lifelong ART for those women eligible for treatment for their own health.”
Are any countries already implementing lifelong treatment as part of PMTCT services?
Yes. EGPAF currently supports five countries that have begun implementing lifelong treatment, including Uganda, Malawi, Mozambique, Lesotho, and Rwanda.
What do the new guidelines mean for treating pediatric HIV?
In addition to boosting PMTCT services and therefore reducing the likelihood a mother will pass HIV to her child, thus decreasing the number of children newly infected with the virus, the guidelines also call for expanded pediatric treatment, including immediate initiation of ART for all HIV-positive children younger than five years of age. This new recommendation shines a light on efforts to treat new and existing pediatric HIV infections, a component that is often overlooked in the global HIV/AIDS response.
Currently, only 28 percent of eligible children living with HIV have access to the medicines they need. Under the new WHO guidelines, all children younger than five years of age will be eligible for, and should receive, treatment.
Is EGPAF advocating for countries to follow the new guidelines?
EGPAF’s priority is to prevent pediatric HIV infection and to eradicate pediatric AIDS through research, advocacy, and prevention and treatment programs. One measure for meeting this goal is to ensure PMTCT access for ALL HIV-infected pregnant women.
EGPAF advocates for universal access to PMTCT and pediatric treatment services, increased program quality, strengthened health systems, enhanced community engagement, and country leadership. In EGPAF-supported countries considering a transition to the new guidelines, EGPAF is supporting each country’s Ministry of Health to advance their national policies and ensure efficient and effective adaptation and implementation. EGPAF also strongly advocates for sufficient planning and resources to evaluate the implementation and maternal/child outcomes associated with the new guidelines.
Download EGPAF’s Technical Bulletin, Haba na Haba, to learn more about the new guidelines: The 2013 World Health Organization Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection - Volume 4, Issue 1 (June 2013)
Johanna Harvey is Senior Communications Officer for the Foundation, based in Washington, D.C.