Antiretroviral drug

Timely linkage to care and treatment by HIV-positive individuals can lead to significant decreases in morbidity and mortality as well as increases in life expectancy and quality of life. Further, there are significant prevention benefits as early initiation on antiretroviral treatment (ART) can significantly reduce HIV transmission to uninfected partners. Modeling exercises also suggest that universal HIV testing coupled with immediate treatment could decrease HIV incidence and virtually eliminate the HIV/AIDS pandemic. To achieve this, the rate of linkage to care must be 100%. This underscores the importance of understanding and addressing barriers to linkage.

Introduction. South Africa has made remarkable progress in rolling out antiretroviral therapy (ART), with the largest number of people (more than 1.4 million) enrolled on antiretrovirals in the world. Decentralisation of services to primary health centres (PHCs) has strengthened retention of patients on ART and reduced the burden of managing uncomplicated cases at referral hospitals.

THIS KWIK-SKWIZ: summarises the changes to the National Antiretroviral Treatment Guidelines. The current guidelines were released in 2010. The changes summarised here were released and implemented in 2012.

This report outlines some of the strategies, tools and policies that have supported the scaling up of treatment during the past decade as well as those that can address persistent or new challenges. The results are presented from a 23-country survey of how consistently these strategies are being implemented. (See Annex 1) The findings demonstrate encouraging progress by some health ministries in adopting many of the enabling policies needed to facilitate scale-up and improve care. Nevertheless, the adoption and implementation of these strategies, tools and policies are lagging in some countries. The survey results provide a mixed picture: 11 of 23 countries have reached antiretroviral therapy coverage of 60% or more.

These recommendations have been developed specifically to address the daily use of antiretrovirals in HIV-uninfected people to block the acquisition of HIV infection. This prevention approach is known as pre-exposure prophylaxis.

At this stage evidence is available from studies with two groups: men and transgender women who have sex with men; and serodiscordant heterosexual couples. In parallel, WHO also is preparing new recommendations on the use of antiretroviral drugs in people living with HIV to prevent transmission of infection.

New WHO guidelines recommend offering HIV testing and counselling to couples, wherever HIV testing and counselling is available, including in antenatal clinics. For couples where only one partner is HIV positive, the guidelines recommend offering antiretroviral therapy to the HIV positive partner, regardless of his/her own immune status (CD4 count), to reduce the likelihood of HIV transmission to the HIV negative partner.

Recent developments suggest that substantial clinical and programmatic advantages can come from adopting a single, universal regimen both to treat HIV-infected pregnant women and to prevent mother-to-child transmission of HIV. This streamlining should maximize PMTCT programme performance through better alignment and linkages with antiretroviral therapy (ART) programmes at every level of service delivery. One of WHO’s two currently recommended PMTCT antiretroviral (ARV) programme options, Option B, takes this unified approach.

These policy guidelines on collaborative TB/HIV activities are a compilation of existing WHO recommendations on HIV-related TB. They follow the same framework as the 2004 interim policy document, structuring the activities under three distinct objectives: establishing and strengthening mechanisms for integrated delivery of TB and HIV services; reducing the burden of TB among people living with HIV and initiating early antiretroviral therapy; and reducing the burden of HIV among people with presumptive TB (that is, people with signs and symptoms of TB or with suspected TB) and diagnosed TB.

The transformation of HIV from almost cer¬tain death to a chronic condition for many people living with HIV in low- and middle-income countries is a significant public health achievement. By the end of 2010, 6.6 million people in low- and middle-income countries – 47% of the total number eligible – had access to antiretrovi¬ral therapy. This represents a dramatic increase from the 300 000 (2.7% of those eli¬gible) on antiretroviral therapy in 2002. This remarkably effective scaling up of access to antiretroviral therapy has been, in large part, due to a drastic fall in antiretroviral drug prices during this period. In 2000, three-drug antiretroviral therapy combinations cost US$ 10 000–15 000 per person, per year.

This report is a preliminary assessment of global investments in research and development
(R&D) devoted to the discovery and development of new therapies and treatment strategies
for HIV. As part of a broader effort to track and analyze HIV/AIDS spending, UNAIDS
commissioned the Treatment Action Group (TAG) and AVAC to measure global R&D spending
for HIV treatment, starting with the year 2009.
From a total of 144 surveyed institutions, 48 funders reported investing $2.5 billion in HIV
treatment R&D in 2009. The scope of HIV treatment R&D included HIV basic science, drug
discovery, drug development, diagnostics, and operational and implementation science on