Year: 2018
Type: article
Abstract: In 2017, the World Health Organization (WHO) published guidelines for the management of advanced human immunodeficiency 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. These 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 simplified 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 intensified adherence interventions should also be proposed to everyone presenting with advanced HIV disease.
Source: Clinical Infectious Diseases
DOI: 10.1093/cid/cix1139
Authors: Nathan Ford, Graeme Meintjes, Alexandra Calmy, Helen Bygrave, Chantal Migone, Marco Vitoria, Martina Penazzato, Lara Vojnov, Meg Doherty, Guideline Development Group for Managing Advanced HIV Disease and Rapid Initiation of Antiretroviral Therapy, Patricia Asero, Rosa Bologna, Mohamed Chakroun, Lucia Chambal, Tom Chiller, Francesca Conradie, Serge Eholie, Lisa Frigati, Diana Gibb, Eric Goemaere, Nelesh Govender, Alison Grant, Nagalingeswaran Kumarasamy, David Lalloo, Thuy Le, Emilio Letang, Dorothy Mbori-Ngacha, Sayoki Mfinanga, Mathieu Nacher, Muhayimpundu Ribakare, Nandi Siegfried, Kenly Sikwese, Nini Tun, Jose E Vidal
Institutions: World Health Organization, University of Cape Town, Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Geneva, University Hospital of Geneva, Médecins Sans Frontières, Médecins Sans Frontières, Médecins Sans Frontières, Médecins Sans Frontières
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,763
Funders: Bill and Melinda Gates Foundation, World Health Organization, UNICEF, U.S. President’s Emergency Plan for AIDS Relief, London School of Hygiene and Tropical Medicine, Wellcome Trust, University of Oxford, National Research Foundation, Universiteit Stellenbosch, Universidade de São Paulo, Rwanda Biomedical Centre, Centers for Disease Control and Prevention, Medical Research Council
OpenAlex ID: W2793836027