Treatment of HIV with the WHO guidlines

1. I S R A A K A M E L M O H A M E D E L A R A B Y
HIV TREATMENT AND
TREATMENT COVERAGE
E-mail: israakamel2125@gmail.com

2. TREATMENT
Not a Cure !
Prevent
replication
Reduces viral
load
Gives a chance
to fight infections
and cancers
Reduces the risk
of transmition to
others
If left untreated progress to AIDS
Treatment as
prevention
strategy (TasP)

3. DRUG CLASSES
Non-nucleoside reverse transcriptase inhibitors
(NNRTIs)
Nucleoside reverse transcriptase inhibitors (NRTIs)
Protease inhibitors (PIs)
Fusion inhibitors
CCR5 antagonists (CCR5s) (also called entry inhibitors)
Integrase strand transfer inhibitors (INSTIs)

4. CHOOSING A REGIMEN
According to:
• Other diseases or conditions that the person with HIV may have.
• Possible side effects of HIV medicines.
• Potential interactions between HIV medicines or between HIV medicines and
other medicines.
• Results of drug-resistance testing.
• Convenience of the regimen.
For example, a regimen that includes two or more HIV medicines combined in one
pill is convenient to follow.
• Any issues that can make it difficult to follow an HIV regimen, such as a busy
schedule that changes from day to day.
• Cost

5. 1ST LINE AND 2ND LINE TREATMENT
2nd line1st line
ChildrenAdults and
adolescents
(includ. preg. And
breast feeding )
Simplified, less toxic, more
convenient
-Adults, adolescents and
children older than 3 yrs:
Once-daily regimens
comprising a non-thymidine
NRTI backbone and one
NNRTI.
-children younger than 3 yrs,
a PI-based regimen is the
preferred approach.
-NNRTI PI + 2NRTIs
-lopinavir/ritonavir
< 3 yrs: remain and improve
adherence
3yrs: NNRTI+2NRTIs≤
should consist of two
(NRTIs) + a ritonavir-
boosted protease
inhibitor (PI).
-Abacavir or
tenovir+lamivudine
zidovudine+lamivudine
-tenovir or
stavudine+lamivudine
Abacavir or
tenovir+lamivudine

7. DRUG RESISTANCE
There is a change in the way the body absorbs the drug.
There are interactions between drugs taken.
Viral mutation during replication and formation of resisting
strains.
Infection with a drug-resistant strain of the virus.
The drug is not taken as prescribed.

8. TREATMENT COVERAGE
Since 2003 access to ART increased rapidly from just400 000
to 11.7 million by the end of 2013 (36% of all PLHIV)
African region 37%
regions of Americas 44%
Eastern Mediterranean region 10%
 European region 22%
 South east Asia 33%
 Western Pacific region 32%
According to the Joint United Nations Program on HIV/AIDS
(UNAIDS), an estimated 15 million PLHIV were on ART by
mid-2015 (about 50% of PLHIV)
and less than 25% of those on ART were virologically
suppressed.

9. COVERAGE AMONG CHILDREN IS
LOWER THAN ADULTS !
Children represent 6% of people receiving ART and 10%
of PLHIV.
Of 3.2 million children estimated to need ART only 32%
accessed treatment Vs 41% of adults in 2014.

11. 90-90-90 TARGETS
UN had formally embraced TasP strategy and proposed a
new global target for HIV treatment
By 2020,
 90% of all PLHIV should know their HIV serostatus,
 90% of people who know their HIV-positive status
should be receiving sustained ART,
 90% of people on ART should achieve sustained
viral suppression.

12. INTERNATIONAL ASSOCIATION OF
PROVIDERS OF AIDS CARE (IAPAC)
Developed the first comprehensive, evidence-based guidelines for optimizing
the HIV care continuum
Aim
HIV testing coverage
linkage to care
treatment coverage
engagement and retention in care, and viral suppression for adults and
adolescents (persons aged 10-19 years).

13. 36 recommendations in six subject areas:
• Optimizing the HIV care environment
• Increasing HIV testing coverage and linkage to care
• Increasing HIV treatment coverage
• Increasing retention in care, ART adherence, and viral suppression
• Adolescents
• Metrics for and monitoring of the HIV care continuum

14. Recommendationsfor increasing HIV treatment coverage
18. The immediate offer of ART after HIV diagnosis, irrespective of CD4 count or
clinical stage, is recommended.
19. First-line ARV regimens with the highest levels of efficacy, lowest adverse
event profiles, and delivered in QD fixed-dose combinations are recommended.
20. Viral load testing at least every 6 months is recommended as the preferred tool
for monitoring ART response.
21. HIV drug resistance testing is recommended at entry into care or prior to ART
initiation and when virologic failure is confirmed.
21a. Where routine access to HIV drug resistance testing is restricted, population-
based surveillance is recommended.
22. Community-located ART distribution is recommended.
22a. The use of community-based pharmacies should be considered.

15. Thank you