The Impact of the 2013 WHO Antiretroviral Therapy Guidelines on the Feasibility of HIV Population Prevention Trials

Ross, E. Clarke; Tanser, Frank; Pei, Pamela P.; Newell, Marie‐Louise; Losina, Elena; Thiébaut, Rodolphe; Weinstein, Milton C.; Freedberg, Kenneth A.; Anglaret, Xavier; Scott, Callie A.; Dabis, François; Walensky, Rochelle P.

doi:10.1310/hct1505-185

Cited by 6 publications

(2 citation statements)

References 47 publications

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“… 6 This was further supported by Ross et al who found that SSA countries had some national explicit policies that targeted increasing ART access in line with the WHO 2013 guidelines on ART. 19 In his study, Hsieh et al indicated that community consultations are crucial if policies are to be effectively implemented. 6 Labhardt et al found that health centres in Lesotho took longer to adopt the new guidelines because of limited knowledge of WHO policy changes.…”

Section: Resultsmentioning

confidence: 99%

The evolution and adoption of World Health Organization policy guidelines on antiretroviral therapy initiation in sub-Saharan Africa: A scoping review

Govere

Chimbari

2020

Southern African Journal of HIV Medicine

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Background: Despite past and present global interventions, the human immunodeficiency virus (HIV) pandemic remains a public health problem in low- and middle-income countries (LMICs). The World Health Organization (WHO) has assisted these countries by providing antiretroviral therapy (ART) policies for adoption and adaptation to local needs.Objectives: This article describes the response of countries in sub-Saharan Africa (SSA), to the WHO’s changing CD4-threshold ART-initiation recommendations of the past two decades.Methods: Relevant articles published in international peer-reviewed journals were accessed via the following search engines: PubMed, Google Scholar, Cochrane, Embase and EBSCOhost. The study’s inclusion criteria were articles published in the English language between 2000 and 2019 that highlighted changes to the CD4 ART-initiation threshold and that focused on the WHO’s ‘commencement of ART’ policy guidelines. Sixteen studies (n = 16) from SSA were identified and included in this review: four are cross-sectional, four deal with cost-effectiveness, four are retrospective, one is a randomised trial and three are observational studies. Only studies conducted in SSA were assessed.Results: Four themes emerged: (1) adoption of the WHO CD4-ART-initiation policy by SSA countries, (2) timely implementation of the changing guideline initiation policy in the region, (3) barriers and facilitators encountered in the implementation of the changing guidelines and (4) description of similarities in policy implementation at country level from 2002 to 2019. Regional studies – cross-sectional, observational, retrospective, cost-effectiveness and randomised have described greater access to ART in SSA. However, barriers remain. The most common barriers to the timely implementation of ‘new’ ART-initiation guidelines were economic constraints, drug stock-outs, delays in obtaining baseline blood-test results and staff shortages.Conclusion: Although countries in SSA have adopted the WHO-ART-CD4 initiation-threshold policy guidelines, implementation has seldom occurred in a timely manner. Barriers have been identified. Whilst a small number of countries have implemented recommendations promptly, for many, the barriers still require to be overcome.

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Section: Resultsmentioning

confidence: 99%

The evolution and adoption of World Health Organization policy guidelines on antiretroviral therapy initiation in sub-Saharan Africa: A scoping review

Govere

Chimbari

2020

Southern African Journal of HIV Medicine

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“…[1]. The de nition of INR is that the virus replication is controlled by cART for 1 year, but the CD4 + T cell count is still less than 200/ul by at least two years after the treatment [2]. On the other hand, the immune responder (IR) is de ned when CD4 + T cell count is greater than 200/ul after the treatment.…”

Section: Introductionmentioning

confidence: 99%

Multiple factors involved in T cell depletion in AIDS patients with immune non-responder to cART

Qian¹,

Hu²,

Zhu³

et al. 2020

Preprint

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Background: The replication of HIV-1 can be effectively controlled by combination antiretroviral therapy (cART) at present. However, in approximately 20% of AIDS patients with undetectable viral load under effective cART, the amount of CD4+ T cells continues to be lower than normal, showing poor immune reconstitution, which is called immune non-responder (INR). The mechanism of immune reconstitution in AIDS patients is still unclear, and thus far there is no effective improvement strategy. Aim: To investigate what factors involved in T lymphocyte depletion in INR patients.Methods: A retrospective analysis of a cohort from Suzhou Infectious Disease Hospital was performed. From October 2015 to April 2019, 29 AIDS patients, whose CD4+ T cells were less than 100/ul before treatment, were included in this study. Laboratory results were obtained from the medical records, including basic clinical information, and the results of Flow cytometer detection for CD4 T cells and ELISA for T cell-related cytokines.Results: According to the number of CD4+ T cells after 24 months of treatment, the 29 patients were divided into two groups: 15 patients with CD4+ T cells <200/ul were INR, and 14 patients with CD4+ T cells >200/ul were immune responder (IR). When Compared with IR patients, the total number of red blood cells and white blood cells, especially T lymphocytes in INR patients, was significantly lower, while programmed cell death protein 1（PD-1）on CD4+T and CD8+ T lymphocyte surface were significantly higher in INR group, which implies that the probability of T cell apoptosis was greatly increased (p<0.05). ELISA results showed that the overall production of T cell-related cytokines were lower in INR group, but the amount of cytokine secreted from each T cell was higher in INR group than that in IR group due to the significant decrease of T cell in this group. Furthermore, the proportion and the killing efficiency of CD56dim subgroup of NK cells were significantly higher in INR group. Conclusion: Multiple factors are involved in the immune reconstitution in AIDS patients, including myelosuppression, T cell destruction enhanced through PD-1 pathway, over-activation of T lymphocyte, and higher killing efficiency of CD56dim subgroup of NK cells.

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A systematic review and cost-effectiveness analyses of the new World Health Organization guidelines for the treatment of HIV-positive adults in India

Patrikar

Kachroo

Sharma

et al. 2019

Medical Journal Armed Forces India

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Background: The World Health Organization (WHO) in 2013 has revised its guidelines on antiretroviral therapy (ART) treatment for human immunodeficiency virus (HIV)epositive adults and further updated it in 2016. Based on the WHO recommendations, in May 2017, National AIDS Control Organisation, India recommended initiation of ART treatment for all people living with HIV, regardless of CD4 count, clinical stage, age, or population. This systematic review aims to assess the clinical effectiveness and cost implication of the new guidelines for India.Methods: A systematic and comprehensive literature search on PubMed, OvidSP, Cochrane Library, and Google Scholar was carried out. Studies reporting either acquired immunodeficiency syndrome (AIDS) or mortality or both as outcome variables were selected. A meta-analysis of the available studies was carried out. The risk ratio was calculated to assess the reduction in AIDS or mortality or both. Cost-effectiveness analysis using health technology principles evaluating the lives saved in terms of incremental cost-effectiveness ratio and cost per quality-adjusted life years gained was carried out.Results: Nine eligible studies were included for the meta-analysis. For India, the pooled relative risk of AIDS or mortality or both being 0.84 (95% confidence interval [CI], 0.76e0.92) and 0.78 (95% CI, 0.68e0.89) for ART initiation at CD4 count of 350 vs CD4 count of 500

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The Impact of the 2013 WHO Antiretroviral Therapy Guidelines on the Feasibility of HIV Population Prevention Trials

Cited by 6 publications

References 47 publications

The evolution and adoption of World Health Organization policy guidelines on antiretroviral therapy initiation in sub-Saharan Africa: A scoping review

The evolution and adoption of World Health Organization policy guidelines on antiretroviral therapy initiation in sub-Saharan Africa: A scoping review

Multiple factors involved in T cell depletion in AIDS patients with immune non-responder to cART

A systematic review and cost-effectiveness analyses of the new World Health Organization guidelines for the treatment of HIV-positive adults in India

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