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WHO Guidelines for treatment monitoring

WHO Guidelines for treatment monitoring. Nathan Ford Dept of HIV/AIDS World Health Organization. WHO ART guidelines evolution. Vitoria M, et al, Current Opinions HIV/AIDS, 2013. WHO ART guidelines evolution. Earlier initiation. Simpler treatment. Less toxic, more robust regimens.

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WHO Guidelines for treatment monitoring

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  1. WHO Guidelines for treatment monitoring Nathan FordDept of HIV/AIDSWorld Health Organization

  2. WHO ART guidelines evolution Vitoria M, et al, Current Opinions HIV/AIDS, 2013

  3. WHO ART guidelines evolution Earlier initiation Simpler treatment Less toxic, more robust regimens Better monitoring Vitoria M, et al, Current Opinions HIV/AIDS, 2013

  4. Recommendations on ART Monitoring • Viral load is recommended as the preferred monitoring approach to diagnose and confirm ARV treatment failure • (strong recommendation, low-quality evidence) • If viral load is not routinely available, CD4 count and clinical monitoring should be used to diagnose treatment failure • (strong recommendation, moderate-quality evidence) • Definition of virological failure: plasma viral load above 1000 copies/ml based on two consecutive viral load measurements after 3 months, with adherence support (6 months post ART) • Higher threshold for DBS and point-of-care technologies

  5. Implementation considerations • ART access should be the first priority: Lack of laboratory tests for monitoring treatment response should not be a barrier to initiating ART • Prioritization: If viral load availability is limited, it should be phased in using a targeted approach to confirm treatment failure. • This may be particularly relevant in populations receiving ARVs to reduce HIV transmission, such as pregnant and breastfeeding women and in sero-discordant couples.

  6. Implementation considerations • Feasibility of phasing in VL capacity (DBS) • PoC viral load on horizon • Enables monitoring of treatment for prevention • Equity • Cost-effectiveness influenced by monitoring approach (frequency, additive or as replacement to CD4)

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