Antiretroviral therapy for HIV infection in adults and adolescents
Recommendations for a public health approach (2006 revision)
This publication is intended to serve as a reference tool for countries with limited resources as they develop or revise national guidelines for the use of ART in adults and postpubertal adolescents (see Annex 9 for pubertal Tanner staging; prepubertal adolescents should follow the WHO paediatric guidelines). The material presented takes updated evidence into account, including new ART treatment options, and draws on the experience of established ART scaleup programmes. The simplified approach, with evidence-based standards, continues to be the basis of WHO recommendations for the initiation and monitoring of ART. The guidelines are primarily intended for use by national and regional HIV programme managers, managers of nongovernmental organizations delivering HIV care services, and other policy-makers who are involved in the scaling up of comprehensive HIV care and ART in resource-limited countries.
The comprehensive, up-to-date technical and clinical information on the use of ART, however, also makes these guidelines useful for clinicians in resource-limited settings. The recommendations contained in these guidelines are made on the basis of different levels of evidence from randomized clinical trials, high-quality scientific studies, observational cohort data and, where insufficient evidence is available, expert opinion. The strengths of the recommendations in Table 1 are intended to indicate the degrees to which the recommendations should be considered by regional and country programmes.
Cost-effectiveness is not explicitly considered as part of the recommendations, although the realities of human resources, health system infrastructures and socioeconomic issues should be taken into account when the recommendations are being adapted to regional and country programmes.
IMPORTANT: ADDENDUM TO 2006 WHO GUIDELINES
NEW DOSAGE RECOMMENDATIONS FOR STAVUDINE (d4T)
Stavudine (d4T) is now recommended at the dose of 30 mg twice daily for all adult and adolescent patients regardless of body weight.[A-III]
Programmatic experience and new scientific evidence have accumulated since release of the 2006 WHO guidelines for antiretroviral treatment of adults and adolescents and those for treating HIV-infected pregnant women and preventing HIV infection in infants. WHO is reviewing these developments with the aim of revising and updating recommendations on these subjects in a coordinated fashion.