The British HIV Association (BHIVA) has announced a recommendation that doctors should discuss the evidence for the effectiveness of antiretroviral treatment as prevention with all patients with HIV, and that antiretroviral medication should be offered to all HIV-positive people who want to protect their partners from the risk of HIV infection – even if they have no immediate clinical need for treatment themselves.

The guidelines stipulate that all patients should be informed of this evidence but no patient should be forced to take treatment for this reason.

The recommendation forms part of new adult antiretroviral treatment guidelines for the United Kingdom issued for consultation this week.

Although BHIVA continues to recommend that people start treatment at a CD4 cell count of 350 or below, the guidelines also recommend that doctors should discuss the evidence that treatment reduces the risk of HIV transmission to partners with patients who have CD4 counts above 350.

If patients want to start treatment to reduce the risk of transmitting HIV to a partner they should be allowed to do so.

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.

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.

Further information on the BHIVA Guidelines is available at: www.bhiva.org
— Keith Alcorn (Aidsmap)
Published: 6 February, 2012