Journal Article > LetterAbstract Only
Lancet HIV. 1 October 2024; Volume 11 (Issue 10); e711-e716.; DOI:10.1016/S2352-3018(24)00173-5
Venter WDF, Gandhi M, Sokhela S, Sikwese K, Bygrave H, et al.
Lancet HIV. 1 October 2024; Volume 11 (Issue 10); e711-e716.; DOI:10.1016/S2352-3018(24)00173-5
Journal Article > CommentaryFull Text
Health and Human Rights Journal. 11 June 2015
Kavanagh M, Cohn J, Mabote L, Meier BM, Williams BG, et al.
Health and Human Rights Journal. 11 June 2015
Recent years have seen significant advances in the science of using antiretroviral medicines (ARVs) to fight HIV. Where not long ago ARVs were used late in disease to prevent sick people from dying, today people living with HIV can use ARVs to achieve viral suppression early in the course of disease. This article reviews the mounting new scientific evidence of major clinical and prevention ARV benefits. This has changed the logic of the AIDS response, eliminating competition between "treatment" and "prevention" and encouraging early initiation of treatment for individual and public health benefit. These breakthroughs have implications for the health-related human rights duties of States. With medical advance, the "highest attainable standard" of health has taken a leap, and with it the rights obligations of States. We argue that access to early treatment for all is now a core State obligation and restricting access to, or failing to provide accurate information about, it violates both individual and collective rights. In a context of real political and technical challenges, however, in this article we review the policy implications of evolving human rights obligations given the new science. National and international legal standards require action on budget, health and intellectual property policy, which we outline.
Journal Article > CommentaryFull Text
Clin Infect Dis. 4 March 2018; Volume 66 (Issue suppl_2); S106-SS110.; DOI:10.1093/cid/cix1139
Ford NP, Meintjes GA, Calmy A, Bygrave H, Migone C, et al.
Clin Infect Dis. 4 March 2018; Volume 66 (Issue suppl_2); S106-SS110.; DOI:10.1093/cid/cix1139
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.