Everyone who has HIV should immediately be put on antiretroviral triple therapy and everyone at risk of becoming infected should be offered protective doses of similar drugs, the World Health Organization said Wednesday as it issued new HIV treatment and prevention guidelines.
The guidelines increase by 9 million the number of people who should get treatment and by untold millions the number who should get protective doses. Previous guidelines recommended them for gay men, prostitutes, people with infected partners and others; the new guidelines effectively bring in millions of women and girls in Africa.
How much that will cost and how it will be paid for are not yet determined.
Advocates around the world welcomed the new guidelines — usually without addressing the cost.
Dr. Mark Dybul, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said the two recommendations were “critically important to moving us toward fast-track treatment and prevention goals.”
Dr. Deborah L. Birx, the United States global AIDS coordinator and head of the President’s Emergency Plan for AIDS Relief, called the new guidelines “transformative to epidemic control.”
HIV specialists generally agree that since no vaccine is on the horizon — and since the long-touted “ABC” strategy of abstinence, being faithful and condoms has not stemmed the epidemic — the best hope is to offer a combination of treatment and prophylaxis.
The Centers for Disease Control and Prevention has advocated that combination for several years now, and some cities that have poured money into putting it into effect — including San Francisco and Vancouver, British Columbia — have seen their epidemics shrink rapidly.
Whether it can be done on a worldwide scale remains to be seen because the expense is enormous, not just for the drugs themselves but for health care systems that can deliver them and monitor their safe use.