New HIV recommendations by WHO

The World Health Organization (WHO) has issued new guidelines focusing on treatment, prevention, and infant feeding in the context of HIV infection, based on the most recent scientific evidence. The key recommendations are published today, and the full guidelines are anticipated to be released in early 2010. The antiretroviral therapy (ART) guidelines were first published in 2002, summarized and simplified in 2003, and updated in 2006. Changes in Recommendations
Specific new treatment recommendations from the WHO include the following:

• Regardless of symptoms, ART should be started at a higher CD4 cell count threshold of 350 cells/mm³ for all HIV-positive patients, including pregnant women. This is a change from the 2006 recommendation to initiate ART at a CD4 cell count of 200 cells/mm³ or below, when most patients are symptomatic. The new recommendation is based on trials published since 2006 showing that earlier initiation of ART is associated with lower morbidity and mortality.
• Because of long-term, irreversible adverse effects, such as peripheral neuropathy and lipoatrophy, the use of stavudine (d4T) should be phased out in all countries. At present, developing countries still widely use stavudine as first-line treatment because of its low cost and widespread availability. Less toxic and equally effective alternatives to stavudine recommended by WHO are zidovudine (AZT) or tenofovir.
• To improve the quality of HIV treatment and care, laboratory monitoring should play an expanded role. Although WHO recommends improved access to CD4 cell count testing and the use of viral load monitoring as needed, the agency stresses that access to ART must not be denied in settings where these monitoring tests are unavailable.