Journal ArticleDOI
Scaling up antiretroviral therapy in resource-limited settings: adapting guidance to meet the challenges.
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TLDR
This review describes the evolution of WHO guidelines for antiretroviral therapy (ART) in HIV-infected individuals, considering the key epidemiological, scientific, programmatic, and political changes over the last decade, and highlights the major trends for the management of the HIV disease in future guidelines revisions.Abstract:
PURPOSE OF REVIEW: This review describes the evolution of WHO guidelines for antiretroviral therapy (ART) in HIV-infected individuals considering the key epidemiological scientific programmatic and political changes over the last decade and highlights the major trends for the management of the HIV disease in future guidelines revisions. RECENT FINDINGS: In the last few years new evidence has emerged supporting the potential preventive benefit of ART in reducing HIV transmission. This together with the potential clinical benefits of earlier initiation of therapy has led to the consideration of the broader strategic use of ART taking into account the clinical and public health benefit and programmatic feasibility. SUMMARY: In 2002 WHO established its first guidelines for ART use primarily focused on a public health approach for resource-limited settings. These recommendations were updated in 2003 2006 and 2010 incorporating progressive changes reflecting progressive increase in the knowledge of HIV pathogenesis development of new drugs and diagnostics and increased experience of HIV treatment and prevention programs. The impact of several international political commitments and scale-up initiatives such as the 3 by 5 Initiative Universal Access targets and the Treatment 2.0 Strategy were also important drivers of the global response increasing the treatment coverage and catalyzing the necessary environment for the establishment of operational and programmatic components for an expanded and sustainable global response to HIV/AIDS.read more
Citations
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Journal ArticleDOI
Adverse events associated with nevirapine and efavirenz-based first-line antiretroviral therapy: a systematic review and meta-analysis.
Zara Shubber,Alexandra Calmy,Isabelle Andrieux-Meyer,Marco Vitoria,Françoise Renaud-Théry,Nathan Shaffer,Sally Hargreaves,Edward J Mills,Nathan Ford +8 more
TL;DR: Compared to NVP, EFV is associated with a lower frequency of severe adverse events, in particular treatment discontinuations, which supports a move toward EFV-based therapy as the preferred first-line treatment regimen for HIV treatment within a public health approach.
Journal ArticleDOI
The future role of CD4 cell count for monitoring antiretroviral therapy
Nathan Ford,Nathan Ford,Graeme Meintjes,Anton Pozniak,Helen Bygrave,Andrew Hill,Trevor Peter,Mary-Ann Davies,Beatriz Grinsztejn,Alexandra Calmy,N. Kumarasamy,Praphan Phanuphak,Pierre Debeaudrap,Marco Vitoria,Meg Doherty,Wendy Stevens,George K. Siberry +16 more
TL;DR: CD4 cell counts will continue to play an important part in initial decisions around ART initiation and clinical management, particularly for patients presenting late to care, and for treatment monitoring where viral load monitoring is restricted, however, in settings where both CD4 cell count and viral load testing are routinely available, countries should consider reducing the frequency.
Journal ArticleDOI
The evolving role of CD4 cell counts in HIV care.
TL;DR: The role of CD4 cell count in the management of people living with HIV is once again changing, most notably with a shift away from using CD4 assays to decide when to start antiretroviral therapy (ART) as mentioned in this paper.
Journal ArticleDOI
Emerging Technologies for Point-of-Care Management of HIV Infection
Hadi Shafiee,ShuQi Wang,Fatih Inci,Mehlika Toy,Timothy J. Henrich,Daniel R. Kuritzkes,Utkan Demirci +6 more
TL;DR: Challenges associated with HIV management in resource-constrained settings are discussed and the state-of-the-art HIV diagnostic technologies for CD4(+) T lymphocyte count, viral load measurement, and drug resistance testing are reviewed.
Journal ArticleDOI
The WHO public health approach to HIV treatment and care: looking back and looking ahead
Nathan Ford,Andrew Ball,Rachel Baggaley,Marco Vitoria,Daniel Low-Beer,Martina Penazzato,Lara Vojnov,Silvia Bertagnolio,Vincent Habiyambere,Meg Doherty,Gottfried Hirnschall +10 more
TL;DR: Implementation of these key public health principles will bring countries closer to the goals of controlling the HIV epidemic and providing universal health coverage.
References
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Journal ArticleDOI
Prevention of HIV-1 Infection with Early Antiretroviral Therapy
Myron S. Cohen,Ying Q. Chen,Marybeth McCauley,Theresa Gamble,Mina C. Hosseinipour,Nagalingeswaran Kumarasamy,James Hakim,Johnstone Kumwenda,Beatriz Grinsztejn,José Henrique Pilotto,Sheela Godbole,Sanjay Mehendale,Suwat Chariyalertsak,Breno Santos,Kenneth H. Mayer,Irving F. Hoffman,Susan H. Eshleman,Estelle Piwowar-Manning,Lei Wang,Joseph Makhema,Lisa A. Mills,Guy de Bruyn,Ian Sanne,Joseph J. Eron,Joel E. Gallant,Diane V. Havlir,Susan Swindells,Heather J. Ribaudo,Vanessa Elharrar,David N. Burns,Taha E. Taha,Karin Nielsen-Saines,David D. Celentano,Myron Essex,Thomas R. Fleming +34 more
TL;DR: In this article, Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples.
Journal ArticleDOI
Prevention of HIV-1 infection with early antiretroviral therapy
TL;DR: The exciting evidence generated by this paper – that antiretroviral treatment of HIV-1 infection definitively reduces the risk of onward transmission of the virus by 96% – was rightly dubbed Science magazine's ‘Breakthrough of the Year’ in 2011.
Journal ArticleDOI
Global epidemiology of hepatitis C virus infection
TL;DR: Because there is no vaccine and no post-exposure prophylaxis for HCV, the focus of primary prevention efforts should be safer blood supply in the developing world, safe injection practices in health care and other settings, and decreasing the number of people who initiate injection drug use.
Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach. 2006 revision.
TL;DR: These guidelines are primarily intended for use by national and regional HIV programme managers managers of nongovernmental organizations delivering HIV care services and other policy-makers who are involved in the scaling up of comprehensive HIV care and ART in resource-limited countries.
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Liver fibrosis progression in human immunodeficiency virus and hepatitis C virus coinfected patients
Yves Benhamou,Marie Bochet,V. Di Martino,Frédéric Charlotte,F. Azria,Anne Coutellier,Michel Vidaud,François Bricaire,Pierre Opolon,Christine Katlama,Thierry Poynard +10 more
TL;DR: In coinfected patients, a low CD4 count, alcohol consumption rate, and age at HCV infection are associated with a higher liver fibrosis progression rate, while HIV seropositivity accelerates HCV‐related liver Fibrosis progression.
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