TY - JOUR
T1 - Managing Advanced HIV Disease in a Public Health Approach
AU - Ford, Nathan
AU - Meintjes, Graeme
AU - Calmy, Alexandra
AU - Bygrave, Helen
AU - Migone, Chantal
AU - Vitoria, Marco
AU - Penazzato, Martina
AU - Vojnov, Lara
AU - Doherty, Meg
N1 - Funding Information:
Acknowledgments. WHO is grateful to the many peer reviewers who provided valuable comments in support of the development of these guidelines. The following people participated in the WHO: Guideline Development Group for managing advanced HIV disease and rapid initiation of antiretroviral therapy: Eduardo Arathoon (Asociacion de Salud Integral, Guatemala), Patricia Asero (International Community of Women Living with HIV, Kenya), Rosa Bologna (Hospital de Pediatría Prof Dr Juan P. Garrahan, Argentina), Mohamed Chakroun (Fattouma Bourguiba Teaching Hospital, Tunisia), Lucia Chambal (Ministry of Health, Mozambique), Tom Chiller (Mycotic Disease Branch, US Centers for Disease Control and Prevention [CDC]), Francesca Conradie (University of the Witwatersrand, South Africa), Serge Eholie (Centre Hospitalier Universitaire de Treichville, Côte d’Ivoire), Lisa Frigati (Tygerberg Hospital and Stellenbosch University, South Africa), Diana Gibb (Medical Research Council, United Kingdom), Eric Goemaere (Médecins Sans Frontières, South Africa), Nelesh Govender (University of the Witwatersrand and National Institute for Communicable Diseases, South Africa), Alison Grant (London School of Hygiene and Tropical Medicine, United Kingdom), Nagalingeswaran Kumarasamy (YRGCARE, India), David Lalloo (Liverpool School of Tropical Medicine, United Kingdom), Thuy Le (Oxford University Clinical Research Unit, Viet Nam), Emilio Letang (Barcelona Institute for Global Health and Ifakara Health Institute, Spain), Dorothy Mbori-Ngacha (UNICEF, Kenya), Sayoki Mfinanga (Muhimbili Medical Research Centre, National Institute for Medical Research, United Republic of Tanzania), Mathieu Nacher (Université de Guyane, French Guiana), Muhayimpundu Ribakare (Rwanda Biomedical Centre, Rwanda), Nandi Siegfried (Independent Clinical Epidemiologist), Kenly Sikwese (African Community Advisory Board, Zambia), Nini Tun (Medical Action Myanmar, Myanmar), Jose E. Vidal (Instituto de Infectologia Emílio Ribas and Universidade de São Paulo, Brazil). Financial support. The development of the WHO guidelines for the management of advanced HIV disease and this supplement was supported by several sources of funding to the HIV Department, mainly funding from the US President’s Emergency Plan for AIDS Relief through the US CDC cooperative agreement and the Bill & Melinda Gates Foundation. G. M. is supported by the Wellcome Trust (grant number 098316) and the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation of South Africa (grant number 64787). This supplement was supported by funds from the Bill & Melinda Gates Foundation.
Funding Information:
Supplement sponsorship. This article appears as part of the supplement “Advanced HIV Disease,” sponsored by the World Health Organization.
Publisher Copyright:
© 2018 World Health Organization.
PY - 2018/3/4
Y1 - 2018/3/4
N2 - 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.
AB - 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.
KW - advanced HIV disease
KW - cryptococcal meningitis
KW - tuberculosis
UR - http://www.scopus.com/inward/record.url?scp=85043401152&partnerID=8YFLogxK
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U2 - 10.1093/cid/cix1139
DO - 10.1093/cid/cix1139
M3 - Article
C2 - 29514232
AN - SCOPUS:85043401152
VL - 66
SP - S106-S110
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
SN - 1058-4838
ER -