CROI: Pre-conference satellite gives sneak preview of WHO ART guidelines

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Science Speaks is in Atlanta, Georgia this week and will be live-blogging from the 20th CROI — Conference on Retroviruses and Opportunistic Infections from Sunday to Wednesday, covering breaking developments from investigators on cure research, new antiretroviral agents, hepatitis, tuberculosis and treatment as prevention.

ATLANTA, GA – Just prior to the opening of CROI 2013, the World Health Organization hosted a satellite session on their upcoming guidelines for the use of antiretroviral drugs for HIV treatment and prevention, slated for release at the International AIDS Society conference in Malaysia—June 30-July 3. Gottfried Hirnshall, HIV lead at the WHO reminded the audience of several hundred people that international agency was developing a “public health approach” to this issue. It is aimed, he said, at ensuring the provision of quality services to the greatest number of people possible in low and middle-income settings.

The evolution of the WHO treatment guidelines (expected to continue in the 2013 release) is an evolution to earlier an initiative pointing to simpler treatments , less toxic and more robust regimens, and improved monitoring. The number of individuals eligible for immediate treatment which now stands at 15 million is expected to increase by at least 5 million people with the new guidelines.

What will be new about the guidelines will be a consolidation of recommendations across populations, a simplification and a reduction in the number of recommended drug regimens for first and second line treatment and recommendations to improve patient monitoring to improve adherence and to reduce treatment failure. Stefano Velloa, co-chair of the adult treatment group of the guidelines panel indicated that there would be a special emphasis on treatment optimization like a new recommendation for a one pill a day fixed-dose-combination to be identified as the preferred first line regimen, more clarity in defining substitution regimens, and a call to accelerate the phasing out of D4T to substitute tenofovir. There will be an increased focus on viral load monitoring with the critical caveat that lack of laboratory capacity should not stall treatment scale-up.

The 30-person treatment panel has struggled to weigh the benefits with the potential risks of earlier treatment initiation . The expected recommendation for treatment initiation in persons with immune cell, or CD4 counts, under 500 will be coupled with a call to prioritize reaching all persons whose CD4 count is under 350 with treatment. There have also been discussions of moving to even earlier treatment initiation in persons with CD4 counts under 1,000, but it was unclear how or if this call for even earlier initiation would be included in the 2013 guidelines.

Stay tuned Monday for breaking news on the VOICE study.

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