WHO指引:每个HIV病患都应接受抗逆转录病毒疗法(ART)


  【24drs.com】根据世界卫生组织于9月30日发布的两篇新指引,每个HIV患者都应尽快接受抗逆转录病毒疗法(antiretroviral therapy,ART),有「重大」风险者则应给予暴露前预防性投药(pre-exposure prophylaxis,PrEP)。
  
  美国疾病控制与预防中心在记者会中赞扬新版的世界卫生组织建议,对于全球对抗HIV来说,这些建议可说是往前迈进一大步,它们可以大幅降低全球HIV的传染,让最需要治疗者增加使用暴露前预防性投药,帮助HIV患者活得更久、更健康。美国感染症协会与HIV药物协会也表示支持这篇新指引。
  
  在之前的世界卫生组织指引中,抗逆转录病毒疗法被建议用于符合CD4细胞计数阈值的患者、以及易感者如肺结核患者和孕妇。这些限制现在都被删除,世界卫生组织估计,全球适合进行治疗的患者数将从2800万增加到全部的3700万名感染者。他们也预估,到2030年,新方法将可预防2100万例死亡与2800万例新感染。
  
  新版建议是根据截至2015年6月止的证据,目前提早公布,属于预定在2016年发表之更新版指引的一部份。
  
  新版建议的证据包括:阿必尚(Abidjan)的「对感染HIV的成年人及早使用抗逆转录病毒疗法的利益与风险(Benefits and Risks of Early Antiretroviral Therapy in HIV-infected Adults) 」、科特迪瓦(ANRS 12136 TEMPRANO)临床试验发现,在CD4细胞计数仍高时开始治疗可减少死亡、AIDS发病率以及严重的非AIDS疾病。CD4细胞计数低于350 cells/mm3的人被视为最优先开始治疗。
  
  报告指出,为了全面贯彻落实新的建议,各国须确保进行检测与治疗,提供良好的照顾与支持资源,以让患者对于治疗有良好的遵从性。
  
  暴露前预防性投药,包括使用tenofovir,现在被建议用于每个有明显感染HIV风险者;之前,它仅被建议用于某些特定对象,包括男男性行为者、伴侣患有HIV者。明显风险的定义是:≧3/100人-年;即将发表的指引将包括确认哪里些人风险最大的信息。
  
  作者们写道,暴露前预防性投药应作为适合之患者与其社区的积极选择,也强调它不应置换或威胁其它预防计划,如使用保险套。
  
  资料来源:http://www.24drs.com/
  
  Native link:WHO Guidelines: Everyone With HIV Should Receive ART

WHO Guidelines: Everyone With HIV Should Receive ART

By Beth Skwarecki
Medscape Medical News

All people infected with HIV should receive antiretroviral therapy (ART) as soon as possible, and those at "substantial" risk should be offered pre-exposure prophylaxis (PrEP), according to new guidelines published September 30 by the World Health Organization.

"These recommendations are a major step forward in the global fight against HIV. They have the potential to dramatically reduce transmission of HIV worldwide, increase the widespread use of PrEP among those who need it most, and help those living with HIV live longer, healthier lives," the Centers for Disease Control and Prevention stated in a news release lauding the new WHO recommendations. The Infectious Diseases Society of America and the HIV Medicine Association also announced their support for the guideline.

In the previous WHO guidelines, ART was recommended for people who met a threshold for CD4 cell count and for vulnerable groups such as those with tuberculosis and pregnant women. Those limitations have now been removed, which the World Health Organization estimates will increase the number of people eligible for treatment from 28 million to all 37 million living with the virus globally. They also project that the new measures will prevent 21 million deaths and 28 million new infections by 2030.

The new recommendations, based on evidence available through June 2015, are being released early. They are part of a guideline update scheduled to be published in 2016.

Evidence informing the new recommendations includes the Benefits and Risks of Early Antiretroviral Therapy in HIV-infected Adults in Abidjan, Cote d'Ivoire (ANRS 12136 TEMPRANO) clinical trial, which found that initiating treatment while CD4 counts are still high reduces death, AIDS incidence, and severe non-AIDS diseases. People with CD4 counts below 350 cells/mm3 are considered high priority for initiating treatment.

To fully implement the new recommendations, the report says, countries need to ensure that testing and treatment are available and to provide good linkage to care and support to make sure people adhere to treatment.

PrEP, including with tenofovir, is now recommended for everyone at substantial risk of contracting HIV; previously it was only recommended for certain groups, including men who have sex with men and people whose partners had HIV. Substantial risk is defined as at least three per 100 person-years; the forthcoming guideline will include information about identifying people most at risk.

PrEP "should be promoted as a positive choice among people for whom it is suitable and their communities," the authors write, emphasizing that it should not "displace or threaten" other preventative programs, such as those promoting condom use.

The authors have disclosed no relevant financial relationships.

"Guideline on When to Start Antiretroviral Therapy and on Pre-exposure Prophylaxis for HIV." WHO. Published online September 30, 2015.

    
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