New international HIV testing guidelines are encouraging couples to test together and for immediate initiation on antiretrovirals for the one testing positive.
The World Health Organisation this week issued the guidelines recommending that a person living with HIV who has an HIV-negative partner (a 'sero-discordant' partnership) be offered HIV treatment regardless of their CD4 cell count level (measure of their immunity).
This would be potentially earlier than they would otherwise be 'eligible' for treatment under current treatment guidelines.
The move by WHO is a reflection of last year's landmark new data that showed that early HIV treatment can prevent the spread of the virus from one person to another by 96% (Human Prevention Trials Network study HPTN 052).
Médecins sans Frontières’ Access Campaign Medical Director, Nathan Ford welcomed the guidelines “as a major advance in the fight against HIV and puts us on the road toward reversing the epidemic.
It's time for policy makers to ensure these recommendations are translated into more people put on treatment to both save lives and prevent infections. Now governments need to stop the drastic decline in support for global HIV that is already having a negative impact in countries where we work."
The Joint United Nations Programme on HIV/AIDS (UNAIDS) has called on on all countries to implement them to reach the targets set in the United Nations 2011 Political Declaration on AIDS.
“Couples can now reap the benefits of antiretroviral therapy, to improve their own health, and to protect their loved ones,” said UNAIDS Executive Director Michel Sidibé. “By encouraging couples to test together, we can provide comprehensive options for HIV prevention and treatment - that they can discuss and manage jointly.”
WHO recommends that antiretroviral therapy be offered to HIV-positive individuals in discordant relationships even when they do not require it for their own health. The guidance also states that it is possible for couples to stay HIV serodiscordant indefinitely if they consistently practice safer sex using condoms.
“I am excited that with the roll out of these new guidelines, millions of men and women have one additional option to stop new HIV infections,” said Mr Sidibé. “This development begins a new era of HIV prevention dialogue and hope among couples.”
According the new guidelines, “couples who test together and mutually disclose their HIV status are more likely than those testing alone to adopt behaviour to protect their partner. Another potential benefit of couples testing together and sharing their results is that they can support each other, if one or both partners are HIV-positive, to access and adhere to treatment and prevent transmission of HIV to children”.
UNAIDS recommends that HIV testing and counselling should always be confidential and initiation of treatment must always be voluntary and never mandatory or coercive. Couples should have access to the full range of HIV prevention options available including the use of male and female condoms and medical male circumcision. They should also be provided with access to health services such as tuberculosis screening and reproductive health services including family planning with access to effective contraceptives and conception counselling for sero-discordant couples.
According to UNAIDS estimates, around 14 million people are eligible for antiretroviral treatment. At the end of 2011, only 6.6 million people were receiving the life-saving medicines. The guidelines recommend that in situations of limited or inadequate resources, people who require antiretroviral therapy for their own health should always be given priority.
Guidance on couples HIV testing and counselling, including antiretroviral therapy for treatment and prevention in serodiscordant couples: Recommendations for a public health approach http://www.who.int/hiv/pub/guidelines/9789241501972/en/index.html