WHO came out with new guidelines re: hiv treatment (see URLhttp://apps.who.int/iris/bitstream/10665/85322/1/WHO_HIV_2013.7_eng.pdf). not so much surprising inthem, but does capsulize many of the recent advances (note that these recommendations are more targeted to resource-poor countries):
–treatments easier, several single pill options, fewer adverse effects
–more programs to detect and treat pregnant women, with decreased mother-to-child transmission
–treating people earlier (eg CD4 <500) with goal to help them and decrease transmission (treatment as prevention)
–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 <5yo
–decentralizing HIV care into primary care (we have been moving in the opposite direction, with residents commenting that “shouldn’t all HIV patients be referred to HIV clinics?”)
–focus on coordinated services — 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
–for Rx — first option is atripla (TNF/FTC (or 3TC)/EFV. if 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 — though we don’t use much lopinivir, more darunivir
–also treatment recs for kids (see article for details )
so, not really add much to what we are doing, though some different focus since these guidelines more focused on resource-poor countries
geoff