Principles and Objectives

1. Antiretroviral Therapy for HIV Infection in Adults and Adolescents in Resource-Limited Settings: Towards Universal AccessRecommendations for a public health approach2006 revision

3. Principles and Objectives • Standardized formulary for 1st and 2nd line ART • NNRTI-based for 1st line • PI/r-based for 2nd line • Simplified patient management and standardized laboratory monitoring • Considerations for women of child-bearing potential, TB and hepatitis coinfected patients, and IDU’s • Advocacy for greater access to ART and wider availability of CD4 and viral load testing • Free drugs at point-of-care • Recommendations based on scientific evidence • Utility for program managers and clinicians

6. First Line ARV Drugs in Adults and Adolescents Preferential 2 NRTI/NNRTI approach AZT or d4T* EFV 3TC or FTC NVP TDF or ABC Triple NRTI alternative approach *Programs encouraged to begin to move away from d4T.

10. When to Switch from 1st Line to 2nd Line ARV Regimens for Treatment Failure

11. Second line ARV drugs in adults and adolescents Standard second-line option if NRTI/NNRTI approach used in first-line therapy ddI or TDF PI/r EFV or NVP NRTI sparing option if the triple NRTI approach used in first-line therapy ABC or3TC (±AZT)

14. Scott Hammer, Columbia University, USA Ayce Riley, MASA National ARV Programme, Botswana Alexandra Calmy, MSF and St. Vincent’s Hospital, Sydney Anthony Harries, National TB Programme, Malawi Chris Duncombe, HIV-NAT, Thailand Diane Havlir, UCSF, USA Elly Katabira, Makerere University, Uganda Fabio Scano, WHO/HTM/STB, Switzerland Jean-Elie Malkin, ESTHER, France Joep Lange, IATEC, Netherlands Joia Murkerjee, Partners in Health, USA Judith Currier, UCLA, USA Lynne Mofenson, NICHD, NIH, USA Mark Harrington, Treatment Action Group, USA Mauro Schechter, Universidade Federal do Rio De Janeiro, Brazil N. Kumarasamy, YRG Centre for AIDS Research and Education, India Papa Salif Sow, University of Dakar, Senegal Paula Munderi, Uganda Virus Research Institute, Uganda Sylvia Ojoo, National AIDS and STI Control Programme, Kenya Pedro Cahn, Fundacion Huesped, Argentina Praphan Phanuphak, Thai Red Cross AIDS Centre, Thailand Sergie Eholie, Treichville Hopital, Cote D’Ivoire Wafaa El-Sadr, Columbia University, USA William Rodriguez, Clinton Foundation, USA Guidelines Development Group

15. Comments and Contributions: Annette Verster, WHO/HTM/HIV, Switzerland Diane Bennett, WHO/HTM/HIV, Switzerland Donald Sutherland, WHO/HTM/HIV, Switzerland Gerald Friedland, Yale University, USA Igor Olyinik, University of Berlin, Germany Jeroen van Gorkorn, KNCV TBC, Netherlands Monica Alonso, WHO/AMRO, USA Silvia Bertagnolio, WHO/HTM/HIV, Switzerland Siobhan Crowley, WHO/HTM/HIV, Switzerland Paula Fujiwara, IUATLD, France Ramzi Asfour, WHO/HTM/HIV, Switzerland Ying Ru-Lo, WHO/SEARO, India Acknowledgements

16. Acknowledgements • Coordinated by (and special thanks to): • Charles Gilks, WHO/HTM/HIV, Switzerland • Marco Vitoria, WHO/HTM/HIV, Switzerland

20. Tiered laboratory capabilities for ART monitoring in resource-limited settings