All HIV patients should have immediate access to treatment, the World Health Organization (WHO) declared Wednesday—a historic call that was applauded by medical experts who cautioned that it's now up to global leaders to make accessible treatment a reality.
Doctors Without Borders/Médecins Sans Frontières (MSF), which welcomed the new guidelines, said donors and governments would have to dramatically increase their support of treatment programs to ensure that all 37 million HIV patients worldwide are given access to antiretroviral therapy (ART).
"Test and treat can turn the tide on HIV, but in [order] to work as a tool to control the epidemic it will require drastic changes and greatly increased investment," said Dr. Tom Ellman, director of MSF's Southern Africa Medical Unit. "HIV care has to move out of clinics and into the communities with mobilized, empowered and engaged people living with HIV that actually are part of the response. This will need effort and money."
WHO made its recommendation following recent clinical trials that showed early ART extends the lives of individuals living with HIV and reduces the risk of transmission.
The organization said its new guidelines are the start of a push to eradicate AIDS by 2030—a lofty goal which was agreed to by world leaders at last week's United Nations Sustainable Development conference.
Those same leaders "are going to need to show that they're serious" about making the disease history within 15 years, Ellman said Wednesday. "Nobody's going to end AIDS with business as usual."
The WHO's previous guidelines only recommended ART for patients whose CD4 count—found in immune cells—had fallen below a particular level, which restricted access to therapy for 28 million people worldwide.
"We are at a crossroads in the response to AIDS," said Michael Sidibé, executive director of UNAIDS, which helped WHO craft its new guidelines. "We know what works—now we need to put people first and fully respect their right to health."
"These new guidelines and recommendations are a highly significant moment in the AIDS response," Sidibé said. "The medicines and scientific tools now at our disposal provide us with a real opportunity to save millions of lives over the coming years and to end the AIDS epidemic by 2030."
MSF said the "treat all" approach would help ensure that people in developing countries would not fall through the cracks of the worldwide treatment system. In the past decade, one-third of people who were diagnosed with HIV but were ineligible for treatment never returned to health clinics, the health nonprofit said.
"In order to reach as many people as possible, as soon as possible, simplified models of care and self-management strategies are needed that allow people to take more control over their own treatment and care," said Dr. Marc Biot, MSF's operational coordinator for HIV.
"It’s no longer only a question of when to start people on treatment, but also how to help people stay on treatment for life and to maintain 'undetectable' levels of virus in their blood. We need to make sure HIV treatment fits into people's lives better, just like with any other chronic disease in industrialized countries," Biot said.