New WHO guidelines for ARV treatment in resource limited settings

HIV Treat Bull - Vol. 7, No. 7/8, September 2006

New WHO guidelines for ARV treatment in resource limited settings

In the week prior to the Toronto conference, the World Health Organization published new online guidelines for adult antiretroviral treatment in resource-limited settings. These revisions are the first changes to guidelines first produced in December 2003.

Changes to this edition include:

• caution against use of d4T (stavudine)-based fixed dose combinations, because of the higher risk of toxicity (peripheral neuropathy, lactic acidosis and facial lipoatrophy)
• that first line treatment should include and NNRTI plus two RTIs or a include three RTI’s, especially when comeidcatioons indicate a risk of drug interactions with NNRTIs
• recommending 3TC (lamivudine) or emtricitabine (FTC) plus either AZT or abacavir or tenofovir as preferred dual-nucleoside combinations
• more detailed discussion about risk of prescribing nevirapine to women with CD4 counts over 250 cells/mm³, or to men with CD4 counts >400 cells/mm³
• support for wider availability and use of CD4 count tests, and stronger caution that total lymphocyte counts are not an effective surrogate marker for either risk of disease progression, or optimum time for starting or changing treatment.

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The decision to drop d4T is undoubtedly a better decision for patients receiving treatment, and inclusion in WHO guidelines will provide a stronger basis for advocates to change treatment choices.

Given the significantly higher cost of the new alternatives, and that many treatment access programmes still only treat a small percentage of people who need treatment, these recommendations are only likely to be effective if the cost of alternative RTIs approaches the current low price for d4T.

Additional WHO guidelines include:

Antiretroviral therapy for HIV infection in adults and adolescents in resource-limited settings: towards universal access

Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants in resource-limited settings: towards universal access

Guidelines on co-trimoxazole prophylaxis for HIV-related infections among children, adolescents and adults in resource-limited settings

WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children

WHO recommendations for clinical mentoring to support scale-up of HIV care, antiretroviral therapy and prevention in resource-constrained settings

Ref:

WHO Guidelines: Antiretroviral therapy of HIV infection in infants and children in resource-limited settings: towards universal access:
http://www.who.int/hiv/pub/guidelines/adult/en/index.html

2006-09-10
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