2013 WHO Consolidated

ARV Guidelines
Summary of Major Recommendations
and Estimated Impact
GSG Briefing
July 19, 2013
Gottfried Hirnschall, Director
HIV Department, WHO
Ak1 Sca|e up : rogress 1owards G|oba| 1argets
WnC G|oba| Ak1 report, 2013
Number of pregnant women ||v|ng w|th nIV need|ng
and rece|v|ng AkVs for M1C1, 200S-2011
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
200S 2006 2007 2008 2009 2010 2011
14
S6
1,S70,000
1,470,000
Plv+ pregnanL women rece|v|ng A8vs for M1C1
Plv+ pregnanL women need|ng A8vs for M1C1
!"#$% '()*+( ,-.)/0 12345
Number of ch||dren acqu|r|ng nIV |nfecnon |n
|ow- and m|dd|e-|ncome countr|es, 1996-2012
No AkV prophy|ax|s for M1C1
Current AkV prophy|ax|s
coverage for M1C1
800,000
ped|atr|c
|nfecnons
averted
~290,000 new ped|atr|c
|nfecnons 2012
!"#$% '()*+( ,-.)/0 12345
2015
201S goa|: 40,000 new
ped|atr|c |nfecnons
30
th
June 2013
01 | Results: The gap between adult and child ART
coverage in 20 high burden
countries is widening



Source: Clobal AluS 8esponse rogress 8eporung (WPC/unlCLl/unAluS) and 2013 unAluS esumaLes.
Clinical
Guidance for
Programme
Managers
nCW 1C DC I1?

Serv|ce de||very
D|agnosncs
Drug supp|y

nCW 1C DLCIDL?

r|or|nzanon
Lqu|ty and eth|cs
Mon|tor|ng & Lva|uanon


WnA1 1C DC?

When to start or sw|tch
Wh|ch reg|men to use
now to mon|tor
Co-|nfecnons &
co-morb|d|nes

Operational
WnC 2013 Conso||dated AkV Gu|de||nes

Simplification and consolidation across:
- Continuum of HIV care
- Ages and populations
- Clinical, operational and programmatic guidance
- Existing and new recommendations

1reaLmenL 2.0
C||n|ca||y re|evant
o Lar||er |n|nanon of Ak1 (CD4 s S00)
o Immed|ate Ak1 for ch||dren < S years
o Ak1 |n|nanon for a|| pregnant and
breasueed|ng women (Cpnon 8]8+) and
||fe|ong Ak1 (Cpnon 8+)
o narmon|zanon of Ak1 across
popu|anons (e.g., adu|ts and pregnant
women) and age groups
o S|mp||hed, fewer, and |ess tox|c
1
st
-||ne reg|mens (1DI]k1C]LIV)
key New kecommendanons
|n 2013 WnC Gu|de||nes

Cperanona||y re|evant
o Use of I|xed Dose Comb|nanons as a
preferred approach
o Improved panent mon|tor|ng to
support beuer adherence and detect
ear||er treatment fa||ure (|ncreased
use of VL)
o kecommend task sh|h|ng,
decentra||zanon, and |ntegranon
o Commun|ty based tesnng to
comp|ement broader n1C
Summary of Changes |n kecommendanons
When to Start |n Adu|ts
1AkGL1
CULA1ICN
!6,7896:7;5
2010 Ak1 GUIDLLINLS 2013 Ak1 GUIDLLINLS
S1kLNG1n CI
kLCCMMLNDA1ICN
& UALI1 CI
LVIDLNCL
Plv+
AS?M1CMA1lC
Cu4 <330 cells/mm
3

CD4 sS00 ce||s]mm
3
(CD4 s
3S0 ce||s]mm
3

as a pr|or|ty)


"#$%&'( )%*+$,#+-
./,01#2 +31*+&4+

Plv+
S?M1CMA1lC
WPC cllnlcal sLage 3 or 4
regardless of Cu4 cell counL
no change
"#$%&'( )%*+$,#+-
./,01#2 +31*+&4+

8LCnAn1 Anu
88LAS1lLLulnC
WCMLn Wl1P Plv
Cu4 <330 cells/mm
3

or
WPC cllnlcal sLage 3 or 4
kegard|ess of CD4 ce||
count or WnC c||n|ca|
stage
"#$%&'( )%*+$,#+-
./,01#2 +31*+&4+

Plv/18 CC-
lnlLC1lCn
resence of acuve 18
dlsease, regardless of Cu4
cell counL
no change
"#$%&'( 0%5-./,01#2
+31*+&4+


Plv/P8v CC-
lnlLC1lCn
Lvldence of chronlc acuve
P8v dlsease, regardless of
Cu4 cell counL
Lv|dence of severe chron|c
n8V ||ver d|sease,
regard|ess of CD4 ce||
count


"#$%&'( 0%5-./,01#2
+31*+&4+

Plv+ A81nL8S ln
Su CCuLL
no recommendauon
esLabllshed
kegard|ess of CD4 ce||
count or WnC c||n|ca|
stage
"#$%&'( 61'6-./,01#2
+31*+&4+

kecommendanons: CD4 Independent
Cond|nons
INI1IA1L Ak1 kLGAkDLLSS CI CD4 CCUN1 Ck CLINICAL
S1AGL
kLCCMMLNDA1ICN


ADUL1S WI1n
nIV.
.and acuve 18 dlsease <0/)=>% ()?8@A+(B0C
-DBE-=F-
.and P8v co-lnfecuon wlLh severe
llver dlsease
<0/)=>% ()?8@A+(B0C
-DBE-=F-
.who are pregnanL or breasueedlng <0/)=>% G)E-/+0-8
@A+(B0C )H -DBE-=F-
.ln a Plv serodlscordanL
parLnershlp
<0/)=>% IB>I8@A+(B0C
-DBE-=F-
CnILDkLN < S
LAkS CLD WI1n
nIV
lnfanLs dlagnosed ln Lhe rsL year of
llfe
<0/)=>% G)E-/+0-8
@A+(B0C )H -DBE-=F-
Chlldren lnfecLed wlLh Plv beLween
one and below ve years of age
J)=EBK)=+(% D-/C8()?8
@A+(B0C -DBE-=F-
kanona|e: Sh|h from Cpnon A to 8+ or 8
Ma[or |ssue now |s not when to start or what to start but whether to stop
8LNLII1S ICk MC1nLk AND CnILD 8LNLII1S ICk kCGkAM DLLIVLk &
U8LIC nLAL1n
Lnsures all A81 ellglble women lnluaLe
LreaLmenL
8educuon ln number of sLeps along M1C1
cascade
revenLs M1C1 ln fuLure pregnancles Same reglmen for all adulLs (lncludlng
pregnanL women)
oLenual healLh beneLs of early A81 for
non-ellglble women
Slmpllcauon of servlces for all adulLs

8educes poLenual rlsks from LreaLmenL
lnLerrupuon
Slmpllcauon of messaglng

lmproves adherence wlLh once dally, slngle
plll reglmen
roLecLs agalnsL Lransmlsslon ln dlscordanL
couples

8educes sexual Lransmlsslon of Plv CosL eecuve
30
th
June 2013
CD4 <3S0*
on Ak1
CD4 <S00*
<Sy
* lncl. co-lnfecLed wlLh 18 or P8v
** **
** only Cu4>300, oLhers lncluded ln adulLs
= 16.7
= 2S.9
2
0
1
0

2
0
1
3

number of people ellglble for A81 ln low- and mlddle-lncome counLrles ln mllllon per WPC
2010 and 2013 A8v guldellnes, based on end of 2012 epldemlc slLuauon
Lsnmated |mpact on Ak1 e||g|b|||ty of |mp|emennng
the new recommendanons
Lsnmated |mpact on |nc|dence and deaths of
|mp|emennng the new recommendanons
WnC G|oba| Ak1 report, 2013
Lsnmated cost of |mp|emennng
the new recommendanons
WnC G|oba| Ak1 report, 2013
10 |ncrease of the 22-24
b||||on USD annua||y for fu|| nIV
response
30
th
June 2013
Ch||d - adu|t coverage gap |s w|den|ng,
other key popu|anons |ag beh|nd
Sw|tch|ng from 2010 to 2013 gu|de||nes
w||| enhance |mpact on ||ves & ep|dem|c
1S by 1S |s w|th|n reach
Global Update on HIV Treatment 2013: Key
Findings and Messages
9.7 m||||on on Ak1,
1.6 more than |n 2011
630 000 ch||dren on Ak1,
on|y 64 000 more than |n 2011
L||g|b|||ty |ncrease from 17 to 26 m
Morta||ty] |nc|dence dec||ne by 1]3
nIV treatment sca|e-up |s pay|ng o
AkVs saved 4.2 m||||on ||ves and
prevented 800 000 ch||d |nfecnons
Many countr|es do we||, but some
need |ntens|hed support
In h|gh burden countr|es, Ak1
coverage var|es from 30 to 90
Next Steps
G|oba| |eve|
Launch of guldellnes aL lAS kL (30 !une 2013)
lull guldellnes
ShorL summarles ln 6 un languages + orLuguese
keg|ona| |eve|
8eglonal dlssemlnauon workshops
All reglons planned for Lhe nexL 3-6 monLhs
un and lmplemenung parLners supporL
Country |eve|
CounLry adapLauon
ollcy and nauonal guldellnes updaLes
lmplemenLauon roll ouL
7/26/13 16
30
th
June 2013
Find the New 2013 WHO Consolidated ARV
Guidelines on www.who.int/hiv