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Guideline

Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach

Year of Publication
2016
Issuing Institution
WHO
Links
Virtual Health Library,WHO IRIS,Google Scholar

Recommendations

162 included recommendations

Second-line ART in adults should consist of two nucleoside reverse-transcriptase inhibitors (NRTIs) plus a ritonavir-boosted protease inhibitor (PI). The following sequence of second-line nucleoside reverse transcriptase inhibitor (NRTI) options is recommended: • After failure on a tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) or emtricitabine (FTC)-based first-line regimen, use AZT + 3TC as the NRTI backbone in second-line regimens. • After failure on an zidovudine (AZT) or stavudine (d4T) + 3TC-based first-line regimen, use TDF + 3TC (or FTC) as the NRTI backbone in second-line regimens.

Status
Retired

Recommended in favor

Strong

Adults and adolescents living with HIV who have an unknown or positive tuberculin skin test (TST) status and are unlikely to have active TB should receive at least 6 months of isoniazid preventive therapy (IPT) as part of a comprehensive package of HIV care. IPT should be given to such individuals regardless of the degree of immunosuppression and also to those on ART, those who have previously been treated for TB and pregnant women

Status
Maintained

Recommended in favor

Strong

Adults and adolescents living with HIV who have an unknown or positive tuberculin skin test status and among whom active TB disease has been safely ruled out should receive at least 36 months of isoniazid preventive therapy (IPT). IPT should be given to such individuals regardless of whether or not they are receiving ART. IPT should also be given irrespective of the degree of immunosuppression, history of previous TB treatment, and pregnancy

Status
Retired

Recommended in favor

Conditional

National or subnational health authorities should decide whether health services will principally counsel and support mothers known to be HIV infected to either breastfeed and receive ARV interventions or avoid all breastfeeding. In settings where national authorities have decided that maternal and child health services will principally promote and support breastfeeding and antiretroviral interventions as the strategy that will most likely give infants born to mothers known to be HIV infected the greatest chance of HIV-free survival, mothers known to be infected with HIV should exclusively breastfeed their infants for the first 6 months of life, introducing appropriate complementary foods thereafter, and continue breastfeeding for the first 12 months of life. Breastfeeding should then stop only once a nutritionally adequate and safe diet without breast-milk can be provided

Status
Retired

Recommended in favor

Conditional

For the induction phase of treatment in HIV-infected adults, adolescents and children with cryptococcal disease (meningeal and disseminated non-meningeal), the following two-week antifungal regimens are recommended in order of preference: c. Amphotericin B short course (5–7 days) + high dose fluconazole (to complete 2 weeks of induction) when a minimum package of pre-emptive hydration and electrolyte replacement and toxicity monitoring and management cannot be provided for the full 2-week induction period

Status
Maintained

Recommended in favor

Conditional

For the consolidation phase treatment of HIV infected adults, adolescents and children with cryptococcal meningitis or disseminated non-meningeal disease, the following 8-week antifungal regimen is recommended: Fluconazole 400–800mg/day after a two-week induction with amphotericin B regimen (6–12 mg/kg/day up to 400–800 mg/day if below 19 years). Fluconazole 800 mg/day after induction treatment with short-course amphotericin B or fluconazole-based induction regimen (fluconazole 12 mg/kg/day up to 800 mg/day if below 19 years)

Status
Maintained

Recommended in favor

Strong

For localized non-meningeal disease, or in patients with isolated serum CrAg positivity (where active cryptococcal meningitis has been excluded). Fluconazole 800 mg/day (or 12 mg/kg/ day if below 19 years) for two weeks, then 400 mg/day (or 6 mg/kg/day up to 400–800 mg/ day if below 19 years) for 8 weeks, and continued maintenance with fluconazole 200 mg/day is recommended. The optimal antifungal regimen in this population remains to be determined

Status
Maintained

Recommended in favor

Strong

In HIV-infected adults, adolescents and children with a recent diagnosis of cryptococcal meningitis, ART initiation should be deferred until there is evidence of a sustained clinical response to antifungal therapy, and after 4 weeks of induction and consolidation treatment with amphotericin B–containing regimens combined with flucytosine or fluconazole, or after 4–6 weeks of treatment with a high-dose oral fluconazole induction and consolidation regimen

Status
Maintained

In HIV-infected adults and adolescents with successfully treated cryptococcal disease (meningeal and non-meningeal), discontinuation of antifungal maintenance treatment is recommended based on the following criteria: a. If HIV viral load monitoring is available: when patients are stable and adherent to ART and antifungal maintenance therapy for at least 1 year and have a CD4 cell count of greater than or equal to 200 cells/mm3 (two measurements 6 months apart)

Status
Maintained

In HIV-infected adults and adolescents with successfully treated cryptococcal disease (meningeal and non-meningeal), discontinuation of antifungal maintenance treatment is recommended based on the following criteria: b. If HIV viral load monitoring is available: when patients are stable and adherent to ART and antifungal maintenance treatment for at least one year and with CD4 cell count of greater than or equal to 100 cells/mm3 (two measurements 6 months apart) and a suppressed viral load

Status
Maintained
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