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WHO Releases Guidelines for HIV Serodiscordant Couples

The World Health Organization (WHO) recently published a report offering guidance for serodiscordant, or mixed status, couples. WHO now recommends that HIV positive partners in such couples should received antiretroviral therapy (ART) for prevention regardless of their own CD4 T-cell count.

Research presented during the past year -- in particular results from the HPTN 052 trial -- have demonstrated that combination ART dramatically reduces the risk of HIV transmission within serodiscordant heterosexual couples. As effective treatment can fully suppress viral load, ART is expected to also have a preventive benefit for men who have sex with men.

The new 54-page report, intended for health officials and policymakers in low- and middle-income countries with large HIV epidemics, offers information on HIV testing, counseling, and use of ART for treatment and prevention in serodiscordant couples.

HIV positive partners are advised to consider starting ART even if their own immune system is not yet impaired, as indicated by a low CD4 count. Many experts believe that treatment starting at the earliest stage of infection is also beneficial for positive people themselves, as recommended in the latest U.S. treatment guidelines.

"New WHO guidelines recommend offering HIV testing and counseling to couples, wherever HIV testing and counseling is available, including in antenatal clinics," the report recommends. WHO estimates that only 40% of people with HIV globally know their status, and that up to half of HIV positive people in ongoing relationships have HIV negative partners.

"By encouraging couples to test together, we can provide comprehensive options for HIV prevention and treatment -- that they can discuss and manage jointly," said UNAIDS Executive Director Michel Sidibé in an agency press release. "I am excited that with the rollout of these new guidelines, millions of men and women have one additional option to stop new HIV infections. This development begins a new era of HIV prevention dialogue and hope among couples."

The full WHO reports is available online at http://www.who.int/hiv/pub/guidelines/9789241501972/en.

5/4/12

Sources

World Health Organization. Guidance on Couples HIV Testing and Counselling, Including Antiretroviral Therapy for Treatment and Prevention in Serodiscordant Couples. April 2012.

UNAIDS. UNAIDS welcomes new guidelines which give an additional HIV prevention option to discordant couples. Press release. April 19, 2012.