According to the World Health Organization (WHO), everyone who has HIV should be offered antiretroviral drugs as soon as possible after diagnosis.
The health agency’s latest policy removes previous limits suggesting patients wait until the disease progresses.
The WHO has also recommended people at risk of HIV be given the drugs to help prevent the infection taking hold.
UNAIDS said these changes could help avert 21 million AIDS-related deaths and 28 million new infections by 2030.
The recommendations increase the number of people with HIV eligible for ARVs from 28 million to 37 million across the world.
The challenge globally will be making sure everyone has access to them and the funds are in place to pay for such a huge extension in treatment. Only 15 million people currently get the drugs.
Michel Sidibe, of UNAIDS, added: “Everybody living with HIV has the right to life-saving treatment. The new guidelines are a very important steps towards ensuring that all people living with HIV have immediate access to antiretroviral treatment.”
The WHO announcement comes after extensive research into the issue.
A US National Institutes of Health study due to run until 2016 was stopped early after an interim analysis found giving treatment straight after diagnosis cut deaths and complications, such as kidney or liver disease, by half.
According to a major scientific study, HIV is evolving into a milder form, becoming less deadly and less infectious.
The research team at the University of Oxford shows the virus is being “watered down” as it adapts to our immune systems.
It said it was taking longer for HIV infection to cause AIDS and that the changes in the virus may help efforts to contain the pandemic.
Some virologists suggest the virus may eventually become “almost harmless” as it continues to evolve.
More than 35 million people around the world are infected with HIV and inside their bodies a devastating battle takes place between the immune system and the virus.
HIV is a master of disguise. It rapidly and effortlessly mutates to evade and adapt to the immune system.
However, every so often HIV infects someone with a particularly effective immune system.
“[Then] the virus is trapped between a rock and hard place, it can get flattened or make a change to survive and if it has to change then it will come with a cost,” said Prof. Philip Goulder, from the University of Oxford.
The “cost” is a reduced ability to replicate, which in turn makes the virus less infectious and means it takes longer to cause AIDS.
This weakened virus is then spread to other people and a slow cycle of “watering-down” HIV begins.
The team showed this process happening in Africa by comparing Botswana, which has had an HIV problem for a long time, and South Africa where HIV arrived a decade later.
The findings in Proceedings of the National Academy of Sciences also suggested anti-retroviral drugs were forcing HIV to evolve into milder forms.
It showed the drugs would primarily target the nastiest versions of HIV and encourage the milder ones to thrive.
The group did caution that even a watered-down version of HIV was still dangerous and could cause AIDS.
HIV originally came from apes or monkeys, in which it is frequently a minor infection.
According to new research, early HIV treatment may not cure the virus as it can rapidly form invulnerable strongholds in the body.
A baby was thought to have been cured with treatment hours after birth, but the virus emerged years later.
Monkey research, published in the journal Nature, suggests untouchable “viral reservoirs” form even before HIV can be detected in the blood.
Experts described it as a “sobering” and “striking” finding.
Reservoirs of HIV in the gut and brain tissue are the massive obstacle in the way of a cure.
Remarkable progress in developing antiretroviral drugs means HIV can be kept in check in the bloodstream and patients have a near-normal life expectancy.
But if the drugs stop, the virus will emerge from its reservoirs.
Early HIV treatment may not cure the virus as it can rapidly form invulnerable strongholds in the body
International research is focused on flushing the virus out of its reservoirs, but there had been hope that early treatment could prevent them forming in the first place.
In the study, rhesus monkeys were infected with the monkey equivalent of HIV – simian immunodeficiency virus (SIV).
The monkeys were then given antiretroviral drugs as early as three days or as late as two weeks after infection.
Treatment stopped after six months, but the virus re-emerged irrespective of how quickly antiretroviral treatment started.
It showed that viral reservoirs formed incredibly early in the course of the infection.
Dan Barouch, professor of medicine at Harvard Medical School, said: “Our data show that in this animal model, the viral reservoir was seeded substantially earlier after infection than was previously recognized.
“We found that the reservoir was established in tissues during the first few days of infection, before the virus was even detected in the blood.”
It had been believed a baby girl born with HIV had been cured after very early treatment.
The “Mississippi baby” was given HIV drugs for the first 18 months of life, but then they were stopped.
Initially the virus did not return and there was hope she had been effectively cured.
But last week it was announced that the girl, now four years old, was no longer in remission after nearly two years off the drugs.
“The unfortunate news of the virus rebounding in this child further emphasizes the need to understand the early and refractory viral reservoir that is established very quickly following HIV infection in humans,” Prof. Dan Barouch added.
Kai Deng and Robert Siliciano, of the School of Medicine at Johns Hopkins University, in Baltimore, Maryland, commented: “These data indicate that the viral reservoir could be seeded substantially earlier than previously assumed, a sobering finding that poses additional hurdles to HIV eradication efforts.
“Although early treatment may not prevent reservoir seeding, it has been consistently shown to reduce the size of the reservoir.”
They highlighted significant differences between these experiments and the human HIV infection, but concluded that the findings “suggest new approaches in addition to early treatment will be necessary to eradicate HIV infection”.
According to a report by the United Nations AIDS agency, there is a chance the AIDS epidemic can be brought under control by 2030.
It said the number of new HIV infections and deaths from AIDS were both falling.
However, it called for far more international effort as the “current pace cannot end the epidemic”.
And charity Medecins Sans Frontieres warned most of those in need of HIV drugs still had no access to them.
The report showed that 35 million people around the world were living with HIV.
There were 2.1 million new cases in 2013 – 38% less than the 3.4 million figure in 2001.
AIDS-related deaths have fallen by a fifth in the past three years, standing at 1.5 million a year. South Africa and Ethiopia have particularly improved.
UNAIDS report said the number of new HIV infections and deaths from AIDS were both falling
Many factors contribute to the improving picture, including increased access to drugs. There has even been a doubling in the number of men opting for circumcision to reduce the risk of spreading or contracting HIV.
While some things are improving, the picture is far from rosy.
Fewer than four in 10 people with HIV are getting life-saving antiretroviral therapy.
And just 15 countries account for three-quarters of all new HIV infections.
The report said: “There have been more achievements in the past five years than in the preceding 23 years.
“There is evidence about what works and where the obstacles remain, more than ever before, there is hope that ending Aids is possible.
“However, a business-as-usual approach or simply sustaining the Aids response at its current pace cannot end the epidemic.”
Michel Sidibe, the executive director of UNAIDS, added: “If we accelerate all HIV scale-up by 2020, we will be on track to end the epidemic by 2030, if not, we risk significantly increasing the time it would take – adding a decade, if not more.”
Dr. Jennifer Cohn, the medical director for Medecins Sans Frontieres’ access campaign, said: “Providing life-saving HIV treatment to nearly 12 million people in the developing world is a significant achievement, but more than half of people in need still do not have access.”
In Nigeria, 80% of people do not have access to treatment.
Dr. Jennifer Cohn added: “We need to make sure no-one is left behind – and yet, in many of the countries where MSF works we’re seeing low rates of treatment coverage, especially in areas of low HIV prevalence and areas of conflict.
“In some countries, people are being started on treatment too late to save their lives, and pregnant women aren’t getting the early support they need.”
A Mississippi girl born with HIV and believed cured after very early treatment has now been found to still harbor the virus.
Tests last week on the 4-year-old child indicate she is no longer in remission, say doctors.
She had appeared free of HIV as recently as March, without receiving treatment for nearly two years.
The news represents a setback for hopes that very early treatment of drugs may reverse permanent infection.
The Mississippi girl had appeared free of HIV as recently as March, without receiving treatment for nearly two years
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told US media the new results were “obviously disappointing” and had possible implications on an upcoming federal HIV study.
“We’re going to take a good hard look at the study and see if it needs any modifications,” he said.
The Mississippi baby did not receive any pre-natal HIV care prior to birth.
Because of a greater risk of infection, she was started on a powerful HIV treatment just hours after labor.
She continued to receive treatment until 18 months old, when doctors could not locate her. When she returned 10 months later, no sign of infection was evident though her mother had not given her HIV medication in the interim.
Repeated tests showed no detectable HIV virus until last week. Doctors do not yet know why the virus re-emerged.
A second child with HIV was given early treatment just hours after birth in Los Angeles in April 2013.
Subsequent tests indicate she completely cleared the virus, but that child also received ongoing treatment.
Only one adult is currently believed to have been cured of HIV.
In 2007, Timothy Ray Brown received a bone marrow transplant from a donor with a rare genetic mutation that resists HIV. He has shown no signs of infection for more than five years.
An international research team has shown how some cells in the body can repel attacks from HIV by starving the virus of the building blocks of life.
Viruses cannot replicate on their own; they must hijack other cells and turn them into virus production factories.
The study, published in Nature Immunology, showed how some parts of the immune system destroy their own raw materials, stopping HIV.
It is uncertain whether this could be used in therapy, experts caution.
HIV attacks the immune system and can weaken the body’s defenses to the point that everyday infections become fatal.
However, not all parts of the immune system become subverted to the virus’ cause. Macrophages and dendritic cells, which have important roles in orchestrating the immune response, seem to be more resistant.
In 2011, researchers identified the protein SAMHD1 as being a critical part of this resistance. Now scientists believe they know how it works.
The scientists have shown that SAMHD1 breaks down the building blocks of DNA. So if a cell needs to make a copy of itself it will have a pool of these building blocks – deoxynucleoside triphosphates or dNTPs – which make the new copies of the DNA. However, they can also be used by viruses.
The study, by an international team of researchers, showed that SAMHD1 lowered the levels of dNTPs below that needed to build viral DNA and prevented infection. When they removed SAMHD1 then those cells had higher levels of dNTPs and were infected by HIV.
The report said: “By depleting the pool of available dNTPs, SAMHD1 effectively starves the virus of a building block that is central to its replication strategy.”
HIV attacks the immune system and can weaken the body's defenses to the point that everyday infections become fatal
It is possible for macrophages and dendritic cells to produce SAMHD1 as they are “mature cells” which do not go on to produce new cells.
Prof. Baek Kim, one of the researchers from the University of Rochester Medical Center, said: “It makes sense that a mechanism like this is active in macrophages.
“Macrophages literally eat up dangerous organisms, and you don’t want those organisms to have available the cellular machinery needed to replicate and macrophages themselves don’t need it, because they don’t replicate.
“So macrophages have SAMHD1 to get rid of the raw material those organisms need to copy themselves. It’s a great host defense.”
Dr. Jonathan Stoye, virologist at the Medical Research Council National Institute of Medical Research, was part of the team which determined the chemical structure of SAMHD1 last year and predicted that it would attack the dNTPs.
“We hypothesized that it works in this fashion and the paper tells us we were right. It is depleting cells of these dNTPs, in cells which are not proliferating (dividing).”
However, some cells do need to divide to boost numbers as part of the immune defence. Such as CD4 cells which are the prime target for HIV infection.
“Cells which are proliferating would be in trouble if we took dNTPs away,” Dr. Jonathan Stoye said.
He added: “How we can use the anti-retroviral action of this protein is not clear to me.”