LogoLogoMSF Science Portal
  • My saved items
logo

© Médecins Sans Frontières

MSF Science Portal
About MSF Science Portal
About MSF
Contact Us
Frequently Asked Questions (FAQs)
Privacy Policy
Terms of Use

v2.1.4829.produseast1

Journal Article > Commentary

Managing advanced HIV disease in a public health approach

Ford NP, Meintjes GA, Calmy A, Bygrave H, Migone C, Vitoria M, Penazzato M, Vojnov L, Doherty M, Asero P, Bologna R, Chakroun M, Chambal L, Chiller T, Conradie F, Eholie SP, Frigati L, Gibb D, Goemaere E, Govender NP, Grant AD, Kumarasamy N, Lalloo DG, Le T, Letang E, Mbori-Ngacha D, Mfinanga S, Nacher M, Ribakare M, Siegfried N, Sikwese K, Tun NL, Vidal JE
Download
Download
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.
Subject Area
models of careHIV/AIDS
DOI
10.1093/cid/cix1139
Published Date
04-Mar-2018
PubMed ID
29514232
Languages
English
Journal
Clinical Infectious Diseases
Volume / Issue / Pages
Volume 66, Issue suppl_2, Pages S106-SS110
Issue Date
04-Mar-2018
Dimensions Badge