New Improved Guidelines on HIV Management For Better Patient Outcome
- Updated guidelines from those issued in 2016 have been released by the International Antiviral Society-USA Panel for use of antiretroviral therapy (ART) in prevention and management of Human Immunodeficiency Virus (HIV) infected adults
- These guidelines address the various stages including HIV testing, preventive measures, treatment and follow-up care of infected persons
- Current recommendations indicate that ongoing advances in ART for HIV prevention and treatment are key and have contributed to improved clinical outcomes (measurable changes in health resulting from patient care) in both prevention and treatment of HIV infection
Latest guidelines formulated by a panel of volunteer international experts in HIV research and patient care have been issued by the International Antiviral Society-USA Panel to prevent and treat adults living with HIV infection
The latest recommendations appear in the Journal of the American Medical Association.
The lead author of the article is Michael Saag, M.D., director of the University of Alabama at Birmingham's Center for AIDS Research.
‘The periodic revision and/or updating of existing guidelines ensures that the latest developments in the areas of HIV prevention, diagnosis, treatment and care get incorporated so that patients receive the best possible care to give the most favorable results.’
The new guidelines are intended to improve the outcome of patients, while starting or maintaining ART, which remains the most effective method of HIV prevention and treatment. Some of the suggested measures include -
- Continuous evaluation of new data and treatment options for initiating therapy
- Followup care of persons starting ART
- Change treatment plan or dose of medicines as required
- Prevention of HIV infection in persons at risk
- Ensure that patients receive best possible treatment and care
According to Saag, Professor of medicine in UAB's Division of Infectious Diseases, "The recommendations reflect the joint commitment of researchers working to collectively improve clinical outcomes and treatments available for all at-risk or infected HIV patients."
Important Features of the Updated Guidelines
The latest guidelines reaffirm the 2016 recommendations of antiretroviral therapy (ART)
as a significant means for HIV treatment and prevention. Some of the key points in this update include the following -
- Rapid institution of antiretroviral therapy, even same-day, if it is practically possible
- Updating earlier treatment programs and drugs, with focus on unboosted integrase strand transfer inhibitors (InSTI) a class of drugs used in treatment of HIV infection
- Recommendations against using mycobacterium avium complex prophylaxis routinely for patients with advanced disease already on effective antiretroviral therapy
- Recommending the stopping of routine CD4 count lab testing once a patient has persistent undetectable HIV RNA levels for a year and has a CD4 count above 250 cells/microliter
- Alternative treatment plans to existing plans for preventing HIV infection in uninfected persons but who remain at risk for HIV infection (pre-exposure prophylaxis); employs an episode-based approach where persons can take prophylactic ART pills before an event that may cause possible exposure to HIV infection, and a follow-up pill once a day for two days following the exposure if exposure to infection occurs (post-exposure prophylaxis)
"HIV care continues to evolve, and clinicians and their patients benefit from applying the latest knowledge to keep pace with the many ways this has changed," said Paul Volberding, M.D., professor at the University of California San Francisco and a study co-author. "The latest IAS-USA guidelines continue a tradition of providing a concise and current set of recommendations, and we are proud of how these have captured the directions in our field of medicine."
All updated guidelines and recommendations focus on adults 18 years or older at risk for or suffering from HIV infection with access to standard ART regimens. Recommendations of HIV Treatment and Prevention Guidelines - 2016
Since the latest guidelines are based on the consolidated 2016 guidelines, here is a brief outline of the previous guidelines of 2016.
The consolidated guidelines document of 2016 focuses on HIV prevention, diagnosis, treatment of infection and associated comorbidities, followup care and delivery of services in the five key populations -
Aim of the 2016 guidelines
- Persons who practise men to men sex
- Intravenous drug users
- People in closed settings e.g. prison
- Sex workers and
- Transgender people
- Providing detailed treatment and prevention measures of HIV infection based on findings of best and latest available research. Better awareness of the important issues and needs of key populations
- Ensure better access, coverage and acceptance of services
- Bring about national and global commitment to ensure adequate funding and services to these populations
- Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection - (http://www.who.int/hiv/pub/arv/arv-2016/en/)
- Fact sheet - Latest statistics on the status of the AIDS epidemic - (http://www.unaids.org/en/resources/fact-sheet)
- Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations - 2016 Update. - (https://www.ncbi.nlm.nih.gov/books/NBK379691/)