THE 2013 World Health Organisation (WHO) consolidated guidelines on the use of anti-retroviral drugs for treating and preventing HIV provide new guidance on the diagnosis of human immuno-deficiency virus (HIV) infection, the care of people living with HIV and use of anti-retroviral (ARV) drugs for treating and preventing HIV infection.
This week, I look at some of the recommendations that were announced in Kuala Lumpa, Malaysia, last year during an HIV/AIDS Conference.
I decided to dwell on this subject because of the many queries I have received as to when one should start Anti-Retroviral Therapy (ART) after being diagnosed HIV positive.
According to a copy of the 2013 guidelines, the key features include the fact that the guidelines respond to new science and emerging practice since 2010.
This includes new and easy-to-use HIV testing technologies and approaches to enable more people, especially those who are most vulnerable and marginalised, to learn their HIV status.
Simpler, safer, once-daily, single-pill treatments that are suitable for use in many populations and age groups have become more affordable and more widely available in resource-limited countries.
There is also a trend towards starting treatment earlier among people with HIV to protect their own health and prevent HIV transmission to others.
Programmes for preventing mother-to-child transmission of HIV (PMTCT) are promoting earlier and simpler treatments to improve the health of pregnant women and mothers living with HIV and to prevent infection among their children and partners.
For the first time, the 2013 guidelines combine recommendations across the continuum of HIV care, including recommendations on HIV testing and counselling, using ARV drugs for HIV prevention, linking individuals to HIV treatment and care services, providing HIV care, initiating and maintaining ART and monitoring treatment.
Guidance is provided on using ARV drugs across all age groups and populations of adults, pregnant and breastfeeding women, adolescents, children and key populations.
The guidelines provide advice on the clinical management of people living with HIV, make recommendations on how to improve the efficiency and effectiveness of HIV services and give guidance on how to plan HIV programmes and use resources most efficiently.
What are the new recommendations? The most outstanding recommendation is the use of viral load testing as the preferred approach to monitoring the success of ART and diagnosing treatment failure in addition to clinical and CD4 monitoring of people on ART;
Support to actively accelerate the phasing out of stavudine (d4T) in first line ARV regimens for adults and adolescents;
A new preferred first-line ART regimen harmonised for adults, pregnant and breastfeeding women and children aged three years and older;
Starting ART at any CD4 count for certain populations with HIV, including people with active TB disease, those with hepatitis B virus (HBV) co-infection with severe chronic liver disease, HIV positive partners in serodiscordant couples, pregnant and breastfeeding women and children younger than five years of age;
Treating adults, adolescents and older children earlier – starting ART in all individuals with a CD4 cell count of 500 cells/mm3 or less and giving priorities to individuals with severe or advanced HIV disease and those with a CD4 cell count of 350 cells/mm3 or less; and community-based HIV testing and counselling and HIV testing of adolescents to diagnose people with HIV earlier and link them to care and treatment.
Globally, an estimated 26 million people living with HIV in low and middle-income countries will be eligible for ARV drugs under the new guidelines compared with the previous close to 17 million people eligible for them in accordance with the 2010 guidelines.
Progressive full implementation of the guidelines could avert as many as three million AIDS-related deaths and 3.5 million new infections between 2013 and 2025 over and above those averted by implementing the 2010 WHO treatment guidelines.
Realising these benefits will require an estimated 10 per cent increase in the total annual investment in the global HIV response.
For now, I pen off but you can certainly expect more next week. For comments write to knoxngoma@gmail.com or SMS/call +260955883143