TREATMENT OPTIMISATION: Edited by David H. Brown Ripin, Charles W. Flexner and Ben PlumleyThe 2013 WHO guidelines for antiretroviral therapy evidence-based recommendations to face new epidemic realitiesDoherty, Meg; Ford, Nathan; Vitoria, Marco; Weiler, Gundo; Hirnschall, GottfriedAuthor Information HIV Department, World Health Organization, Geneva, Switzerland Correspondence to Meg Doherty, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland. Tel: +41 22 791 19 49; fax: +41 22 791 21 11; e-mail: [email protected] Current Opinion in HIV and AIDS: November 2013 - Volume 8 - Issue 6 - p 528-534 doi: 10.1097/COH.0000000000000008 Buy Metrics Abstract Purpose of review The review summarizes the key new recommendations of the WHO 2013 guidelines for antiretroviral therapy and describes the potential impact of these recommendations on the HIV epidemic. Recent findings The 2013 WHO guidelines recommend earlier initiation of antiretroviral therapy (ART) at CD4 500 cells/μl or less for all adults and children above 5 years. Further recommendations include initiation of ART irrespective of CD4 cell count or clinical stage for people co-infected with active tuberculosis disease or hepatitis B virus with severe liver disease, pregnant women, people in serodiscordant partnerships, and children under 5 years of age. The ART regimen comprising a once daily fixed-dose combination of tenofovir + lamivudine (or emtricitabine) + efavirenz is recommended as the preferred first-line therapy. Several approaches are also recommended to reach more people and increase health service capacity, including community and self-testing, and task shifting, decentralization, and integration of ART care. Summary If fully implemented, the 2013 WHO ART guidelines could avert at least an additional 3 million deaths and prevent close to an additional 3.5 million new infections between 2012 and 2025 in low- and middle-income countries, compared with previous treatment guidelines. © 2013 Lippincott Williams & Wilkins, Inc.