Universal ART on diagnosis: approved by NHS England

Simon Collins, HIV i-Base

After several years of consultation, and two years after WHO guidelines recommended universal ART, NHS England will commission immediate ART for anyone who is diagnosed HIV positive. [1]

The announcement was made at the end of 2017, to take effect from 1 April 2018.

The press release notes that an estimated 3000 people are expected to directly benefit from this updated policy in the first year.

Officially, commissioning still remained at only providing ART once the CD4 count approached 350 cells/mm3.


The clinical evidence supporting the benefit of early ART was sufficiently strong in July 2015 (following the results of the START study) that WHO guidelines indicated an immediate notice to change with a rapid updates later in 2015. [2, 3]

The process for NHS England was considerably slower.

Luckily, most doctors were able to ignore the official commissioning policy by prescribing early ART under an indication to prevent HIV transmission.


  1. NHS news. NHS England announces new specialised treatments for patients. (18 December 2017).
  2. Collins S. Starting HIV treatment at high CD4 counts protects against both AIDS and non-AIDS events: overall and in subgroup analyses of START study. HTB 01 August 2015.
  3. Clayden P. New directions in the 2015 WHO ART guidelines. HTB, July 2015.

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