{"id":127,"date":"2013-10-07T17:33:59","date_gmt":"2013-10-07T17:33:59","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=127"},"modified":"2017-08-21T13:10:11","modified_gmt":"2017-08-21T13:10:11","slug":"primary-care-corner-with-geoffrey-modest-md-who-hiv-guidelines-focused-on-resource-poor-countries","status":"publish","type":"post","link":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2013\/10\/07\/primary-care-corner-with-geoffrey-modest-md-who-hiv-guidelines-focused-on-resource-poor-countries\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: WHO HIV guidelines focused on resource poor countries"},"content":{"rendered":"<p>WHO came out with new guidelines re: hiv treatment\u00a0(see\u00a0URL<a href=\"http:\/\/apps.who.int\/iris\/bitstream\/10665\/85322\/1\/WHO_HIV_2013.7_eng.pdf\">http:\/\/apps.who.int\/iris\/bitstream\/10665\/85322\/1\/WHO_HIV_2013.7_eng.pdf<\/a>). not so much surprising inthem, but does capsulize many of the recent advances (note that these recommendations are more targeted to resource-poor countries):<\/p>\n<p>&nbsp;<\/p>\n<p>&#8211;treatments easier, several single pill options, fewer adverse effects<\/p>\n<p>&#8211;more programs to detect and treat pregnant women, with decreased mother-to-child transmission<\/p>\n<p>&#8211;treating people earlier (eg CD4 &lt;500) with goal to help \u00a0them and decrease transmission (treatment as prevention)<\/p>\n<p>&#8211;treating all HIV individuals independent of CD4 who have active TB, hep b with severe liver dz, if pt with serodiscordant partner, pregnant\/breast-feeding women, children &lt;5yo<\/p>\n<p>&#8211;decentralizing HIV care into primary care (we have been moving in the opposite direction, with residents commenting that &#8220;shouldn&#8217;t all HIV patients be referred to HIV clinics?&#8221;)<\/p>\n<p>&#8211;focus on coordinated services &#8212; getting patients into care, making sure they stay in care, med adherence (ie integrated service models). community-based models of education, prevention, early treatment, support<\/p>\n<p>&#8211;for Rx &#8212; first option is atripla (TNF\/FTC (or 3TC)\/EFV. \u00a0if not tolerated, consider AZT\/3TC\/EFV, or AZT\/3TC\/NVP (we use much less nevaripine in the US than much of the rest of the world, and prob for good reason, though NVP is cheaper), or TDF\/FTC (or 3TC)\/NVP. prefer as second line: 2 NRTIs plus ritonivir-boosted PI (atazanivir or lopinivir &#8212; though we don&#8217;t use much lopinivir, more darunivir<\/p>\n<p>&#8211;also treatment recs for kids (see article for details )<\/p>\n<p>&nbsp;<\/p>\n<p>so, \u00a0not really add much to what we are doing, though some different focus since these guidelines more focused on resource-poor countries<\/p>\n<p>&nbsp;<\/p>\n<p>geoff<\/p>\n","protected":false},"excerpt":{"rendered":"<p>HIV guidelines from WHO, especially for low resource settings [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2013\/10\/07\/primary-care-corner-with-geoffrey-modest-md-who-hiv-guidelines-focused-on-resource-poor-countries\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-127","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/127","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=127"}],"version-history":[{"count":0,"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/127\/revisions"}],"wp:attachment":[{"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=127"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=127"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=127"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}