The British HIV Association (BHIVA) today recommends that doctors should discuss the evidence for the effectiveness of antiretroviral treatment as prevention with all patients with HIV, and that it should be offered those who want to protect their partners from the risk of HIV infection – even if they have no immediate clinical need for treatment themselves.
Evidence from a large trial of the effects of earlier antiretroviral treatment on HIV transmission to partners has convinced UK doctors that treatment should be offered in circumstances where patients are concerned about the risk of transmitting HIV to partners – even if they are not in a serodiscordant relationship at the time.
All patients should be informed of this evidence, the guidelines say, but no patient should be forced to take treatment for this reason.
Patients should also be told that the evidence of a lower risk of transmission on treatment mainly relates to vaginal sex, not anal sex, and that use of condoms will continue to protect against sexually transmitted infections as well as lowering any residual risk of HIV transmission.
The recommendation forms part of new adult antiretroviral treatment guidelines for the United Kingdom issued for consultation this week.
After rigorous review of the published evidence, British doctors have concluded that the UK will stick with a CD4 cell count of 350 cells as the threshold for starting treatment in the majority of patients.
In contrast, United States guidelines recommend treatment in patients with CD4 counts up to 500 cells, though noting the absence of evidence from randomised trials to support this guidance.
The new UK guidelines also make a clear recommendation on the two nucleoside drugs that should be used as the basis of first-line antiretroviral treatment. The guidelines committee has concluded that the balance of evidence favours tenofovir and emtricitabine (FTC), combined in Truvada, as the preferred option for patients in the UK.
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