The new recommendations were published on 30 November 2009, the eve of World AIDS Day.

Earlier initiation of antiretroviral therapy (ART) is proposed for adults and adolescents, as well as the delivery of more patient-friendly antiretroviral drugs (ARVs) and prolonged use of ARVs to reduce the risk of mother-to-child transmission of HIV.

For the first time, WHO also advises that HIV-positive mothers or their infants take ARVs while breastfeeding to prevent HIV transmission.

“These new recommendations are based on the most up-to-date available data,” said Dr Hiroki Nakatani, Assistant Director General for HIV/AIDS, TB, Malaria and Neglected Tropical Diseases at the World Health Organisation. “Their widespread adoption will enable many more people in high-burden areas to live longer and healthier lives.”

An estimated 33.4 million people are living with HIV/AIDS, and there are some 2.7 million new infections each year. Globally, HIV/AIDS is the leading cause of mortality among women of reproductive age.

In 2006, WHO advised that all patients start ART when their CD4 count (a measure of immune system strength) falls to 200 cells/mm³ or lower, at which point they typically show symptoms of HIV disease. Since then, studies and trials have clearly demonstrated that starting ART earlier reduces rates of death and disease.

WHO is now recommending that ART be initiated at a higher CD4 threshold of 350 cells/mm³ for all HIV-positive patients, including pregnant women, regardless of symptoms.

WHO also proposes that countries phase out the use of Stavudine, or d4T, because of its long-term, irreversible side-effects. Stavudine is still widely used in first-line therapy in developing countries due to its low cost and widespread availability.

Zidovudine (AZT) or Tenofovir (TDF) are recommended as less toxic and equally effective alternatives.

The 2009 recommendations outline an expanded role for laboratory monitoring to improve the quality of HIV treatment and care. They recommend greater access to CD4 testing and the use of viral load monitoring when necessary. However, access to ART must not be denied if these monitoring tests are not available.

The recommendations, if adopted, will result in a greater number of people receiving treatment. However, WHO believes the associated costs of earlier treatment may be offset by decreased hospital costs, increased productivity due to fewer sick days, fewer children orphaned by AIDS and a drop in HIV infections.

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