Managing Advanced HIV Disease in a Public Health Approach

Nathan Ford, Graeme Meintjes, Alexandra Calmy, Helen Bygrave, Chantal Migone, Marco Vitoria, Martina Penazzato, Lara Vojnov, Meg Doherty

Research output: Contribution to journalArticle

Abstract

In 2017, the World Health Organization (WHO) published guidelines for the management of advanced human immunodefciency virus (HIV) disease within a public health approach. Recent data suggest that more than a third of people starting antiretroviral therapy (ART) do so with advanced HIV disease, and an increasing number of patients re-present to care at an advanced stage of HIV disease following a period of disengagement from care. Tese guidelines recommend a standardized package of care for adults, adolescents, and children, based on the leading causes of morbidity and mortality: tuberculosis, severe bacterial infections, cryptococcal meningitis, toxoplasmosis, and Pneumocystis jirovecii pneumonia. A package of targeted interventions to reduce mortality and morbidity was recommended, based on results of 2 recent randomized trials that both showed a mortality reduction associated with delivery of a simplifed intervention package. Taking these results and existing recommendations into consideration, WHO recommends that a package of care be offered to those presenting with advanced HIV disease; depending on age and CD4 cell count, the package may include opportunistic infection screening and prophylaxis, including fluconazole preemptive therapy for those who are cryptococcal antigen positive and without evidence of meningitis. Rapid ART initiation and intensifed adherence interventions should also be proposed to everyone presenting with advanced HIV disease.

Original languageEnglish (US)
Pages (from-to)S106-S110
JournalClinical Infectious Diseases
Volume66
DOIs
StatePublished - Mar 4 2018

Keywords

  • advanced HIV disease
  • cryptococcal meningitis
  • tuberculosis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Fingerprint Dive into the research topics of 'Managing Advanced HIV Disease in a Public Health Approach'. Together they form a unique fingerprint.

  • Cite this

    Ford, N., Meintjes, G., Calmy, A., Bygrave, H., Migone, C., Vitoria, M., Penazzato, M., Vojnov, L., & Doherty, M. (2018). Managing Advanced HIV Disease in a Public Health Approach. Clinical Infectious Diseases, 66, S106-S110. https://doi.org/10.1093/cid/cix1139