November 2009
WHO Library Cataloguing-in-Publication Data
Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents -November 2009 [electronic version].
1.Antiretroviral agents - pharmacology. 2.HIV infections - therapy. 3.HIV infections - prevention and control. 4.Adolescent. 5.Adult. 6.Guidelines. 7.Developing countries.
I.World Health Organization.
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Rapid advice
Antiretroviral therapy for HIV infection
in adults and adolescents
November 2009
Abbreviations
3TC lamivudine
ABC abacavir
ART antiretroviral therapy
ARV antiretroviral (drug)
ATV atazanavir
AZT zidovudine (also known as ZDV)
bPI boosted protease inhibitor
CD4 T-lymphocyte bearing CD4+ receptor
CDC Centers for Disease Control and Prevention
CIPRA HT001 Comprehensive International Program of Research on AIDS in Haiti (clinical trial)
DART Development of Antiretroviral Therapy in Africa (clinical trial)
d4T stavudine
ddI didanosine
EFV efavirenz
FBC full blood count
FDC fixed-dose combination
FTC emtricitabine
GRADE Grading of Recommendations, Assessment, Development and Evaluation
HBAC Home Based AIDS Care (clinical trial)
HIV human immunodeficiency virus
HBV hepatitis B virus
IAS International AIDS Society
IRIS immune reconstitution inflammatory syndrome
LPV lopinavir
NNRTI non-nucleoside reverse transcriptase inhibitor
NRTI nucleoside reverse transcriptase inhibitor
NVP nevirapine
PEPFAR US President’s Plan for Emergency AIDS Relief
PI protease inhibitor
PMTCT prevention of mother-to-child transmission
PLHIV people living with HIV
/r low-dose ritonavir
RCT randomized clinical trial
RTI reverse transcriptase inhibitor
RTV ritonavir
SAPIT Starting Antiretroviral Therapy at Three Points In Tuberculosis Therapy (clinical trial)
TB tuberculosis
TDF tenofovir disoproxil fumarate
VL viral load
UNAIDS Joint United Nations Programme on HIV/AIDS
WHO World Health Organization
Contents
Abbreviations 2
1. Overview 4
1.1 Background 4
5. Declarations of interest 8
7. Key recommendations 10
8. References 15
9. Annex 1 17
1. Overview
1.1 Background The target audience is primarily national treatment advisory
groups.
The guideline Antiretroviral therapy for hiv infection in adults and
adolescents, developed by World Health Organization (WHO),
The key recommendations contained herein are released as Rapid
was first published in 2002, simplified in 2003 and was updated
advice because several countries with the highest burden of HIV
in 2006. The guideline continues to follow the principles of a
infection currently are in the process of changing their national
public health approach, aiming to optimize outcomes, including
guideline for HIV treatment and care, and updating estimates for
the quality of life and survival, of people living with HIV (PLHIV),
2010 Universal Access reporting. This Rapid advice focuses on
and to act as a reference tool for countries to adopt and adapt
two key areas of the full guideline; when to start ART and what
according to their national circumstances.
ARVs to use in adults, adolescents, pregnant women, tuberculo-
sis (TB) and hepatitis B (HBV) co-infection.
During 2009, WHO has worked to update the guideline through
a series of coordinated efforts to review and synthesize emerging
1.3 Guiding principles
evidence on when to initiate antiretroviral therapy (ART), what
drug regimens to use, and the management of co-infections and The ART Guideline Review Committee discussed and agreed
treatment failure. This evidence has been assembled following upon a set of principles that should be used in developing national
systematic reviews, GRADE* profile preparation and analysis, treatment recommendations. The principal consideration was
consultations with PLHIV, cost and economic impact studies, that public health interventions should secure the greatest
country-level feasibility assessment, and comparisons of current likelihood of survival and quality of life for the greatest numbers
country guidelines. of PLHIV.
1. Do no harm
The groups who developed this revised guideline were: an When introducing changes preserve access for the sickest
internal WHO ART Guideline Working Group (convened in and most in need.
April 2009), the ART Guideline Drafting Group (convened in
September 2009), the external ART Peer Review Panel (con- 2. Ensure access and equity
vened in September 2009), and the full ART Guideline Review All clinically eligible people should be able to enter treatment
Committee (convened in October 2009). The members are listed services (including ART) with fair and equitable distribution
in Annex 1. of treatment services.
4
5 Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents
2. The revision process
2.1 Retrieving, summarizing and presenting the 2.2 Consensus, external review and updating
evidence
Existing recommendations were reviewed and revised at the
The PICO** questions to be considered were agreed upon by September 2009 meeting of the ART Guideline Drafting Group.
the internal WHO ART Guideline Working Group in May 2009. Based on presentations and individual review of the available
A series of activities then were undertaken to prepare for the evidence described above, the group compiled risk-benefit
October 2009 guideline review meeting: analysis for each area of interest. A table that includes the follow-
ing domains: existing recommendations; new recommendations;
1. GRADE profiles were prepared for the key PICO questions:
quality and grade of evidence for the critical outcomes (mortality,
i. when to start ART;
disease progression and serious adverse events); benefits; risks;
ii. what to use in first-line and second-line antiretroviral
values; acceptability; costs; feasibility; gaps and research needs
regimens;
was prepared for each set of recommendations. Disagreements
iii. when to switch to a second-line regimen.
were debated during plenary and group sessions and consensus
2. Systematic reviews of the literature were conducted on ARV sought.
drug interactions with drugs for TB, hepatitis, malaria, and
opioids; ART management for HIV/HBV co-infection; ART The ART Peer Review Panel reviewed and revised the risk-
toxicity summaries for tenofovir, zidovudine, nevirapine benefit tables and draft recommendations prepared by the ART
and stavudine; the safety of efavirenz; the teratogenicity of Guideline Drafting Group and responded with their comments
efavirenz; a low-dose stavudine safety profile; and reviews of and other input via the ART Guidelines 2009 page of WHO’s
CD4 and viral load laboratory technologies. EZCollab website. Reviewers debated and exchanged ideas within
EZCollab and during teleconferences. Their suggestions and com-
3. An impact assessment was conducted to estimate the
ments were collated and posted on the EZCollab website. The
number of PLHIV in need of treatment according to various
revised recommendations were presented to the ART Guideline
proposed CD4 initiation thresholds.
Review Committee in October 2009.
4. Consultations were conducted with three organizations
representing PLHIV and the findings summarized. At the October 2009 ART Guideline Review Meeting, each
subject area was reviewed, discussed and consensus sought on
5. Costing information was prepared based on studies of
each recommendation and the ranking of each recommendation.
procurement and production of ARVs.
6. A feasibility assessment was conducted for the introduction The full guideline document will be reviewed again by 2012.
of the proposed guideline in Malawi (a similar assessment is
ongoing in Tanzania).
The GRADE evidence profiles, and the full set of supporting docu-
mentation will be included and or referenced in the guideline.***
5
3. Guideline timing and publication
This Rapid advice: antiretroviral therapy for HIV infection in adults
and adolescents will be published online. Given the short life-span
of the Rapid Advice, it will be posted online in English. However,
requests from WHO Regional Offices for translation into other
languages will be supported from WHO Headquarters.
6
7 Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents
4. Dissemination, adaptation, implementation and evaluation
WHO is working closely with WHO Regional and Country
Offices, UN and other implementing partners to plan for rapid
dissemination, adaptation and implementation of the new
recommendations. Much experience has been obtained from
previous ART guidelines, and active support for guideline revision
at country level is needed. Key steps in the dissemination include:
The WHO and UNAIDS are finalizing the global and country tools
required for estimations of treatment and resource needs, in time
for 2010 universal access reporting.
7
5. Declarations of interest
Forms were collected from every member of each group. Two
declarations were made and were determined not to constitute
conflicts of interest by the core guideline team. The ART Peer
Review Panel was advised via the WHO’s EZCollab website of a
member’s declaration of potential conflict (P. Cahn) and the ART
Peer Review Panel concluded that there was no conflict of inter-
est. The declaration of potential conflict of a member of the ART
Guideline Review Committee (C. Holmes) was discussed with
the assembled ART Guideline Review Committee at the October
2009 meeting. The ART Guideline Review Committee concluded
that there was no conflict of interest.
8
9 Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents
6. Collaboration with external partners
There are no external collaborators specific to this Rapid advice.
However, several partners have been engaged in the develop-
ment of the guideline. All collaborations will be detailed in the full
guideline.
9
7. Key recommendations
Recommendation 1 Recommendation 2
When to start What to start
1. Start antiretroviral treatment in all patients with HIV who Start one of the following regimens in ART-naïve individuals
have CD4 count <350 cells/mm3 irrespective of clinical eligible for treatment.
symptoms. AZT + 3TC + EFV
(Strong recommendation, moderate quality of evidence) AZT + 3TC + NVP
TDF + 3TC or FTC + EFV
2. CD4 testing is required to identify if patients with HIV and
TDF + 3TC or FTC + NVP
WHO clinical stage 1 or 2 disease need to start antiretroviral
(Strong recommendation, moderate quality of evidence)
treatment.
(Strong recommendation, low quality of evidence)
Remarks: In developing these recommendations the panel placed
3. Start antiretroviral treatment in all patients with HIV and high value on avoiding the disfiguring, unpleasant and potentially
WHO clinical stage 3 or 4 irrespective of CD4 count. life threatening toxicity of d4T, the need to select regimens suitable
(Strong recommendation, low quality of evidence) for use in most patient groups, and the benefits of using fixed dose
combinations.
Remarks: In developing these recommendations, the panel placed
high value on avoiding death, disease progression and HIV transmis- Current evidence suggests that these regimens are comparable in
sion over and above cost and feasibility. The recommendations are terms of efficacy, with a better overall toxicity profile than d4T based
supported by moderate quality of evidence for critical patient and regimens. The panel was reassured by the GRADE profile evidence
public health outcomes from one RCT, the CIPRA-HT001 (a single- from RCTs, non-randomised trials and observational studies from
centre trial in Haiti) and one post hoc analysis nested in a RCT, the low- middle-income countries that indicate no superiority of AZT
SMART trial (a multicentre study in 33 predominantly high income over TDF, or NVP over EFV as part of combination ART for treatment-
countries).1, 2 In the GRADE profile, pooled data from these two stud- naïve individuals.
ies provide moderate evidence that starting ART at CD4 levels higher
than 200 or 250 cells/mm3 reduces mortality rates in asymptomatic, On the issue of progressive reduction in the use of d4T, in settings
ART-naive, HIV-infected people. The panel also reviewed large where d4T regimens are used as the principal option for starting ART,
observational data sets from both resource limited and high resource countries should develop a plan to move towards AZT- or TDF-based
settings which are consistent with data from the RCTs but these did first-line regimens, based on an assessment of the cost and feasibility.
not add to the overall quality of the evidence. 3-6 The panel considered Systems to prevent, monitor and manage d4T-related toxicities
that starting ART earlier is feasible if introduced in a phased manner, should be implemented.
with the speed and completeness determined by health system
capacity, HIV burden, ART coverage, equity of access and funding. It is recommended that programs select the preferred regimen(s)
applicable to the majority of PLHIV. The introduction of safer but
Considering the uncertain prognostic value of some WHO clinical currently more expensive first-line ARTs needs to be phased-in as
stage 2 conditions and recent modelling and observational data sug- currently they may not be feasible or affordable in many high-burden
gesting that more than 50% of HIV-infected patients with this clinical settings with low coverage, less developed health systems, limited
stage have a CD4 count of <350 cells/mm3, the panel recommended laboratory capacity, finite budgets and competing health priorities.
HIV-infected individuals with WHO clinical stage 1 and 2 should have In countries with high coverage and more developed health systems,
access to CD4 testing to decide if treatment should be initiated. transition to new treatment regimens should occur sooner.
10
11 Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents
Recommendation 3 Recommendation 4
ART for HIV/tuberculosis co-infection ART for HIV/HBV co-infection
1. Start ART in all HIV-infected individuals with active tubercu- 1. Start ART in all HIV/HBV co-infected individuals who require
losis (TB) irrespective of CD4 cell count. treatment for their HBV infection, irrespective of CD4 cell
(Strong recommendation, low quality of evidence) count or WHO clinical stage.
(Strong recommendation, low quality of evidence)
2. Start TB treatment first, followed by ART as soon as possible
after starting TB treatment. 2. Start TDF and 3TC or FTC containing antiretroviral regimens
(Strong recommendation, moderate quality of evidence) in all HIV/HBV co-infected individuals needing treatment.
(Strong recommendation, moderate quality of evidence)
3. Use efavirenz (EFV) as the preferred non-nucleoside reverse
transcriptase inhibitor (NNRTI) in patients starting ART
Remarks: In developing these recommendations, the panel placed
while on TB treatment.
high value on promoting HBV diagnosis and more effective treatment
(Strong recommendation, high quality of evidence)
of HIV/HBV co-infection.
Further modeling suggests that starting ART less than five years after
initial HIV infection could reduce the incidence of TB by 60% to 70%.
(B Williams, submitted for publication)
11
Recommendation 5 transmission and death.13 There is no evidence to suggest an increase
ART for pregnant women in maternal serious adverse events and no studies specifically
evaluating maternal response to ART. Pregnancy registry data on the
1. Start ART in all pregnant women with HIV and CD4 count
use of TDF in pregnancy show no signals to raise concern, and there
<350 cells/mm3, irrespective of clinical symptoms.
is no evidence to suggest that TDF+3TC or FTC is not an acceptable
(Strong recommendation, moderate quality of evidence)
alternative to AZT+3TC.14
2. CD4 testing is required to identify if pregnant women with
HIV and WHO clinical stage 1 or 2 disease need to start There is very low quality, conflicting evidence on the risks of EFV
antiretroviral treatment or prophylaxis. causing neural tube defects. The overall rates of birth defects
(Strong recommendation, low quality of evidence) reported in association with EFV, NVP, lopinavir/ritonavir (LPV/r)
or TDF appear similar and are consistent with rates reported in
3. Start ART in all pregnant women with HIV and WHO clinical
congenital defects’ registries from general populations. Since neural
stage 3 or 4, irrespective of CD4 count.
tube closure occurs in the first 28 days and very few pregnancies are
(Strong recommendation, low quality of evidence)
recognised by this time, the actual risks from starting EFV based ART
4. Start one the following regimens in ART-naïve pregnant in the first trimester are difficult to estimate.
women eligible for treatment.
(Strong recommendation, moderate quality of evidence) The review of NVP safety in pregnant women with CD4 count
AZT + 3TC + EFV 250–350 cells/mm3 did not confirm an increased risk of serious
AZT + 3TC + NVP adverse events and the panel concluded that the benefits of using
TDF + 3TC or FTC+ EFV NVP in this situation outweigh the risks of not initiating ART.
TDF + 3TC or FTC + NVP
The panel was unable to conclude from the evidence reviewed
5. Do not start EFV during the first-trimester of pregnancy.
whether there are benefits associated with the use of EFV vis a vis
(Strong recommendation, low quality of evidence)
NVP in pregnant women after the first trimester and with higher
or unknown CD4 cell counts, although more than half of the panel
Remarks: In developing these recommendations, the ART and
members preferred EFV in these situations.
PMTCT panels placed high value on ensuring treatment is started
early for pregnant women with HIV to avoid mother-to-child
transmission and improve maternal and child-health outcomes, over
and above concerns for the cost or feasibility.
12
13 Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents
Recommendation 6 Recommendation 7
When to switch ART Second-line ART
1. Where available, use viral load (VL) to confirm treatment 1. A boosted protease inhibitor (PI/r) plus two nucleoside
failure. analogues (NRTIs) are recommended for second-line ART.
(Strong recommendation, low quality of evidence) (Strong recommendation, moderate quality of evidence)
2. Where routinely available, use VL every 6 months to detect 2. ATV/r and LPV/r are the preferred boosted PI’s for second-
viral replication. line ART.
(Conditional recommendation, low quality of evidence) (Strong recommendation, moderate quality of evidence)
3. A persistent VL above 5 000 copies/ml confirms treatment 3. Simplification of second NRTI options is recommended.
failure. • If d4T or AZT has been used in first-line, use TDF + 3TC
(Conditional recommendation, low quality of evidence) or FTC as the NRTI backbone in second-line.
• If TDF has been used in first-line, use AZT + 3TC as the
4. When VL is not available, use immunological criteria to
NRTI backbone in second-line.
confirm clinical failure.
(Strong recommendation, moderate quality of evidence)
(Strong recommendation, moderate quality of evidence)
13
Recommendation 8
Third-line regimens
1. National programmes should develop policies for third-line
therapy that consider funding, sustainability and the provi-
sion of equitable access to ART.
(Conditional recommendation, low quality of evidence)
14
15 Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents
8. References
1. Severe P, Pape J, Fitzgerald D et al. A Randomized Clinical Trial of Early Versus Standard Antiretroviral Therapy for HIV-Infected
Patients with a CD4 T Cell Count of 200-350 Cells/ml (CIPRAHT001). 49th Interscience Conference on Antimicrobial Agents
and Chemotherapy; San Francisco, 2009; Abstract H-1230c.
2. Emery S, Neuhaus JA, Phillips AN, Babiker A, Cohen CJ, Gatell JM, et al. Major clinical outcomes in antiretroviral
therapy (ART)-naive participants and in those not receiving ART at baseline in the SMART study. J Infect Dis. 2008 Apr
15;197(8):1133-44.
3. Moh R, Danel C, Messou E, Ouassa T, Gabillard D, Anzian A, et al. Incidence and determinants of mortality and morbidity
following early antiretroviral therapy initiation in HIV-infected adults in West Africa. AIDS. 2007 Nov 30;21(18):2483-91.
4. Badri M, Bekker LG, Orrell C, Pitt J, Cilliers F, Wood R. Initiating highly active antiretroviral therapy in sub-Saharan Africa: an
assessment of the revised World Health Organization scaling-up guidelines. AIDS. 2004 May 21;18(8):1159-68.
5. Erhabor O, Ejele OA, Nwauche CA. The effects of highly active antiretroviral therapy (HAART) of stavudine, lamivudine
and nevirapine on the CD4 lymphocyte count of HIV-infected Africans: the Nigerian experience. Niger J Clin Pract. 2006
Dec;9(2):128-33.
6. Wong KH, Chan KC, Cheng KL, Chan WK, Kam KM, Lee SS. Establishing CD4 thresholds for highly active antiretroviral therapy
initiation in a cohort of HIV-infected adult Chinese in Hong Kong. AIDS Patient Care STDs. 2007 Feb;21(2):106-15.
7. Abdool-Karim SS, Naidoo K, Grobler A, Padayatchi N, Nair G, Bamber S et al. Initiating ART during TB Treatment Significnatly
Increases Survival: Results of a Randomized Controlled Clinical trial in TB/HIV co-infected Patients in South Africa. 16th
Conference on Retroviruses and Opportunistic Infections; Montreal, 2009. Oral abstract 36a. [Available from http://www.
retroconference.org/Abstracts/34255.htm ]
8. Lawn SD, Churchyard G. Epidemiology of HIV-associated tuberculosis. Curr Opin HIV AIDS. 2009 Jul;4(4):325-33.
9. Middelkoop K, Wood R, Myer L, Sebastian E, Bekker LG. Can antiretoviral therapy contain a previously escalating TB epidemic
in a high HIV prevalemce community. 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention; 2009; Cape Town.
Abstract CDB 041 [Available from http://www.ias2009.org/pag/Abstracts.aspx?AID=2932]
10. Golub JE, Astemborski J, Ahmed M, Cronin W, Mehta SH, Kirk GD, et al. Long-term effectiveness of diagnosing and treating
latent tuberculosis infection in a cohort of HIV-infected and at-risk injection drug users. J Acquir Immune Defic Syndr. 2008
Dec 15;49(5):532-7.
11. Atun RA, Lebcir RM, Drobniewski F, McKee M, Coker RJ. High coverage with HAART is required to substantially reduce the
number of deaths from tuberculosis: system dynamics simulation. Int J STD AIDS. 2007 Apr;18(4):267-73.
12. Matthews GV, Avihingsanon A, Lewin SR, Amin J, Rerknimitr R, Petcharapirat P, et al. A randomized trial of combination
hepatitis B therapy in HIV/HBV coinfected antiretroviral naive individuals in Thailand. Hepatology. 2008 Oct;48(4):1062-9.
13. Bae WH, Wester C, Smeaton LM, Shapiro RL, Lockman S, Onyait K, et al. Hematologic and hepatic toxicities associated
with antenatal and postnatal exposure to maternal highly active antiretroviral therapy among infants. AIDS. 2008 Aug
20;22(13):1633-40.
14. The antiretroviral pregnancy registry [database on the Internet]. Antiretroviral Pregnancy Registry Steering Committee. 2009.
[Available from http://www.apregistry.com/forms/interim_report.pdf]
15. Coutinho A, Mermin J, Ekwaru J, Were W, R Bunnell, Kaharuza F et al. Utility of Routine Viral Load, CD4 Cell Count,
and Clinical Monitoring among HIV-infected Adults in Uganda: A Randomized Trial. 15th Conference on Retroviruses
and Opportunistic Infections; 2008; Boston, Abstract 125. [ Available from http://www.retroconference.org/2008/
Abstracts/30881.htm]
15
16. Mugyenyi P, Walker S Hakim J, Munderi P , Gibb D , Kityo C , et al. Impact of routine laboratory monitoring over 5 years after
antiretroviral therapy (ART) initiation on clinical disease progression of HIV-infected African adults: the DART trial final results
2009. 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention; 2009; Cape Town. Abstract TUSS 102 [Available
from http://www.ias2009.org/pag/Abstracts.aspx?AID=3807]
17. Arribas JR, Pulido F, Delgado R, Lorenzo A, Miralles P, Arranz A, et al. Lopinavir/ritonavir as single-drug therapy for maintenance
of HIV-1 viral suppression: 48-week results of a randomized, controlled, open-label, proof-of-concept pilot clinical trial (OK
Study). J Acquir Immune Defic Syndr. 2005 Nov 1;40(3):280-7.
18. Escobar I, Pulido F, Perez E, Arribas JR, Garcia MP, Hernando A. [Pharmacoeconomic analysis of a maintenance strategy with
lopinavir/ritonavir monotherapy in HIV-infected patients]. Enferm Infecc Microbiol Clin. 2006 Oct;24(8):490-4.
19. Cameron DW, da Silva Barbara A, Arribas Jose R, Myers Robert A, Bellos Nicholaos C, Gilmore N, et al. A 96‐Week
Comparison of Lopinavir Ritonavir Combination Therapy Followed by Lopinavir‐Ritonavir Monotherapy versus Efavirenz
Combination Therapy. J Infect Dis. 2008;198(2):234-40.
20. J. Arribas AH, J. Gerstoft, G. Fatkenheuer, M. Nelson, N. Clumeck, F. Pulido et al. The MONET trial: darunavir/ritonavir
monotherapy shows non-inferior efficacy to standard HAART, for patients with HIV RNA < 50 copies/mL at baseline. 5th IAS
Conference on HIV Pathogenesis, Treatment and Prevention; 2009; Cape Town. Abstract .TUAB 106-LB [Available from http://
www.ias2009.org/pag/Abstracts.aspx?AID=3626]
21. Katlama C, Valentin MA, Algarte-Genin M, Duvivier C, Lambert-Niclot S, Girard PM et al. Efficacy of darunavir/ritonavir
as single-drug maintenance therapy in patients with HIV-1 viral suppression: a randomized open-label non-inferiority trial,
MONOI-ANRS 136. 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention; 2009; Cape Town. Abstract WELBB
102. [Available from http://www.ias2009.org/pag/Abstracts.aspx?AID=3689]
22. Delfraissy JF, Flandre P, Delaugerre C, Ghosn J, Horban A, Girard PM, et al. Lopinavir/ritonavir monotherapy or plus zidovudine
and lamivudine in antiretroviral-naive HIV-infected patients. AIDS. 2008 Jan 30;22(3):385-93.
23. Molina JM, Andrade-Villanueva J, Echevarria J, Chetchotisakd P, Corral J, David N, et al. Once-daily atazanavir/ritonavir versus
twice-daily lopinavir/ritonavir, each in combination with tenofovir and emtricitabine, for management of antiretroviral-naive
HIV-1-infected patients: 48 week efficacy and safety results of the CASTLE study. Lancet. 2008 Aug 23;372(9639):646-55.
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17 Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents
9. Annex 1
World Health Organization Mathias Egger (HIV Researcher/Epidemiologist)
Professor of Epidemiology & Public Health
2009 ART guideline review meeting Institute of Social & Preventive Medicine
Hotel Ramada Encore, Geneva, 14–16 October 2009 University of Bern
Finkenhubelweg 11
CH-3012 Bern,
List of Participants Switzeland
egger@ispm.unibe.ch
ART Guideline Review Committee
Lori Bollinger (Health Economist) Shaffiq Essajee (Implementing Partner)
Vice President Director of Clinical Operations
Futures Institute Senior Advisor in Pediatrics
41-A New London Turnpike Clinton Foundation HIV/AIDS Initiative
Glastonbury, CT 06033 USA
USA sessajee@clintonfoundation.org
lbollinger@futuresinstitute.org
Loon Gangte (PLHIV representative)
Alexandra Calmy (Hiv Researcher/Clinician) President,
Cheffe de clinique scientifique Delhi, Network of Positive People (DNP+)
Service de Maladies Infectieuses Gali No.3,House No-64
Unité VIH/SIDA Neb Sarai,
Université de Genève New Delhi-1100 68
Switzerland India
alexandra.calmy@hcuge.ch loon_gangte@yahoo.com
17
Charles Holmes (Implementing Partner) Lynne Mofenson (HIV Researcher/Clinician)
Senior Technical Advisor Pediatric, Adolescent and Maternal AIDS
Office of the US Global AIDS Coordinator Branch Center for Research for Mothers and Children Eunice
S/GAC, SA-29, 2nd Floor Kennedy Shriver National Institute of Child Health and Human
Washington, DC 20522-2920 Development
USA National Institutes of Health
holmescb@state.gov 6100 Executive Boulevard, Room 4B11
Rockville, MD 20852
Elizabeth Humphreys (GRADE methodologist) USA
Cochrane Collaborative Group on HIV/AIDS lm65d@nih.gov
University of California
San Francisco Paula Munderi (HIV Researcher/Clinician)
USA Medical Research Council Programme on AIDS
elizahumphreys@gmail.com Uganda Virus Research Institute
PO Box 49
Robert Mwanri Josiah (Implementing Partner) Entebbe
Head, Care And Treatment Unit Uganda
National Aids Control Programme (NACP) paula.munderi@mrcuganda.org
Luthuli Road,
P.O. BOX 11875 Irene Mukui (Programme Implementer)
Dar Es Salaam Ministry of Public Health and Sanitation
Tanzania Department of Diseases Prevention and Control
rmwjosiah@gmail.com Kenyanta Hospital Ground
P. O. Box 19982-00202
Ayesha Khan (Programme Implementer) Nairobi
Infectious Diseases and M&E Specialist Kenya
Health Systems Strengthening and Policy Unit (HSSPU) njahira2004@yahoo.com
Ministry of Health
Health Services Academy Mutinta Nalubamba-Phiri (Programme Implementer)
Chak Shahzad, Islamabad Paediatric ART Programme Officer
Pakistan P.O.Box 32588,
ayakhan@gmail.com Lusaka
Zambia
Stephen Lawn (TB/HIV Researcher) drtinta@yahoo.com
Reader in Infectious Diseases & Tropical Medicine
Desmond Tutu HIV Centre, IIDMM, University of Cape Town, Portia Ngcaba (PLHIV Representative)
Anzio Road, Observatory, 9758 TAC Eastern Cape Provincial Coordinator
Cape Town NGO Sector
South Africa Treatment Action Campaign
stevelawn@yahoo.co.uk 57 a Paterson Street Arcadia
East London
Jean-Paul Moatti (Health Economist) South Africa
UMR INSERM/IRD 912 portia@mail.tac.org.za
ORS PACA
23 rue Stanislas Torrents
13006 Marseille
France
jean-paul.moatti@inserm.fr
18
19 Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents
Sylvia Ojoo (Implementing partner) Papa Salif Sow (HIV researcher/clinician)
Senior Medical Technical Adviser, AIDSRelief Dakar University Hospital
Institute of Human Virology of the Fann Hospital BP
University of Maryland, School of Medicine 5035 Dakar
KREP Centre, Wood Avenue, Kilimani Senegal
PO Box 495, 00606 salifsow@orange.sn
Nairobi
Kenya Erik Schouten (implementing partner)
sylvia_ojoo@yahoo.co.uk Technical Assistant for Co-ordination of HIV and AIDS
Programmes
Vladimir Osin (PLHIV representative) Department of HIV and AIDS
Public Relations Manager Ministry of Health
Psychological centre “Dvizhenie” P.O. Box 30377
Moscow Lilongwe
Russia Malawi
osin.vladimir@gmail.com eschouten.mw@gmail.com
19
Augustin Okenge Yuma (Programme implementer) WHO staff
Directeur
Shelley Agarwall
PNLS Programme National de Lutte contre le VIH/SIDA et les
Intern
ISTTel
Antiretroviral Treatment and HIV Care
Kinshasa
Democratic Republic of Congo
Silvia Bertagniolo
dokenge@yahoo.fr
Medical Officer
Antiretroviral Treatment and HIV Care
Oleg Yurin (HIV researcher/epidemiologist)
Deputy Head of Federal AYDS Centre, Leading Researcher of
Txema Calleja
Central Institute of Epidemiology
Medical Officer
Moscow
Strategic Information
Russia
oleg_gerald@mail.ru
Siobhan Crowley
Acting Coordinator
Megan O’Brien (HIV researcher)
Antiretroviral Treatment and HIV Care
Clinton Foundation HIV/AIDS Initiative
55 West 125th Street
Micheline Diepart
New York, NY10027
Medical Officer
USA
Antiretroviral Treatment and HIV Care
mobrien@clintonfoundation.org
Boniface Dongbo
Suzanne Crowe (HIV researcher/laboratory )
Technical Officer
Head, Centre for Virology
Systems Strengthening and HIV
Burnet Institute
85 Commercial Road, Melbourne, Victoria, Australia 3004
Chris Duncombe
GPO Box 2284, Melbourne, Victoria,
Consultant
Australia
Antiretroviral Treatment and HIV Care
crowe@burnet.edu.au
Sally Girvin
Elliot Raizes (observer) (implementing partner)
Consultant
Care and Treatment Branch
Antiretroviral Treatment and HIV Care
NCHSTP/GAP
CDC
Reuben Granich
MS-E04
Medical Officer
1600 Clifton Road NE
Antiretroviral Treatment and HIV Care
Atlanta, GA 3033
USA
Teguest Guerma
gwq0@cdc.gov
Acting Director
HIV/AIDS Department
Frank Lule
AFRO
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21 Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents
Jacqueline Ying-Ru Lo UNAIDS staff
Coordinator
Carlos Avila
Prevention in the Health Sector
Adviser
AI/RTN Resource Tracking, Needs and Costing Unit
Neil Parkin
Medical Officer
Anja Grujovic
Antiretroviral Treatment and HIV Care
Technical Officer
AI/AFR AIDS Financing & Economic Division
Francoise Renaud-Thery
Medical Officer
Systems Strengthening and HIV
Nathan Shaffer
Medical Officer
Prevention in the Health Sector
Omar Sued
HIV Treatment and Care
PAHO HIV/STI Project (FCH/HI)
525 23rd St. NW
Washington, DC 20037
USA
Yves Souteyrand
Coordinator
Strategic Information
Marco Vitoria
Medical Officer
Antiretroviral Treatment and HIV Care
Dharani Yerrakalva
Intern
Antiretroviral Treatment and HIV Care
Stop TB
Haileyesus Getahun
Medical Officer
TB/HIV and Drug Resistance
Delphine Sculier
Medical Officer
TB/HIV and Drug Resistance
21
ART Peer Review Panel Jean-Baptiste Guiard-Schmid (programme implementer)
Inter Country Adviser
2009 revision of Antiretroviral therapy for HIV
World Health Organization
infection in adults and adolescents Inter-country Support Team - West Africa
03 BP 7019 Ouagadougou03
Xavier Anglaret (HIV researcher/epidemiologist) Burkina Faso
Senior Researcher guiardschmidjb@bf.afro.who.int
INSERM U897
Université Bordeaux 2 Mark Harrington (HIV/AIDS policy)
33076 Bordeaux Cedex Executive Director
France Treatment Action Group
Xavier.Anglaret@isped.u-bordeaux2.fr 611 Broadway, Suite 308
New York, NY 10012
Veronique Bortolotti (programme implementer) USA
Medical officer, HIV care and treatment and PMTCT markhar@gmail.com
WHO EMRO
AIDS and Sexually Transmitted Diseases (ASD) Unit Elly Katabira (HIV researcher/clinician)
World Health Organization Professor
Regional Office of the Eastern Mediterranean Makerere Medical School
Abdul Razzak Al-Sanhouri St. Department of Medicine
P.O. Box 7608 Nasr City School of Medicine
Cairo 11371 Makerere University College of Health Sciences
Egypt P. O. Box 7072
Bortolottiv@emro.who.int Kampala
Uganda
Pedro Cahn (HIV researcher/clinician) katabira@imul.com
Director
Fundacion Huesped Ricardo Kuchenbecker (HIV researcher/clinician)
Angel Peluffo 3932 Professor of Medicine
C1202ABB - Buenos Aires Federal University of Rio Grande do Sul
Argentina Hospital de Clínicas de Porto Alegre
pcahn@huesped.org.ar Rua Ramiro Barcelos, 2350
90035-903 Porto Alegre, RS
Serge Paul Eholié (HIV researcher/clinician) Brazil
Unit of Infectious Diseases rkuchen@gmail.com
Treichville University Hospital
BPV3 CHU Treichville Barbara Marston (implementing partner)
Abidjan, Medical Officer
Ivory Coast Centers for Disease Control and Prevention
speholie@afnet.net 1600 Clifton Road
Atlanta GA 30333 MS-E-04
USA
bmarston@cdc.gov
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23 Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents
Padmini Srikantiah (programme implementer) ART Guideline Drafting Group
Medical Officer
2009 revision of Antiretroviral therapy for HIV
WHO-SEARO
World Health House infection in adults and adolescents
Indraprastha Estate
Mahatma Gandhi Marg Dr Alexandra Calmy (HIV researcher/clinician)
New Delhi 110001 Cheffe de clinique scientifique
India Service de Maladies Infectieuses
srikantiahp@searo.who.int Unité VIH/SIDA
Université de Genève
Scott Hammer (HIV researcher/clinician) Switzerland
Chief, Division of Infectious Diseases
Columbia University Larry William Chang (GRADE methodologist)
630 West 168th Street Johns Hopkins School of Medicine
PH 8 West, Room 876 1503 E. Jefferson St.
New York, New York 10032 Baltimore, MD 21287
USA USA
smh48@columbia.edu larrywillchang@gmail.com
23
Dr Elliot Raizes (Implementing partner) Dr Reuben Granich
Care and Treatment Branch Medical Officer
NCHSTP/GAP Anti-retroviral Treatment and HIV Care
CDC
MS-E04 Dr Kerry Kutch
1600 Clifton Road NE External Relations Officer
Atlanta, GA 3033 HIV/AIDS Department
USA
Ms Sally Girvin
Dr. Paul J. Weidle Consultant
(HIV researcher/epidemiologist) Antiretroviral Treatment and HIV Care
CAPT, USPHS
Research Support Officer Dr Tin Tin Sint
Epidemiology Branch Medical Officer
Division of HIV/AIDS Prevention Prevention in the Health Sector
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention Dr Marco Vitoria
1600 Clifton Rd, MS E-45 Medical Officer
Atlanta, GA 30333 Antiretroviral Treatment
USA
UNAIDS staff
Dr Carlos AVILA-FIGUEROA
AI/RTN Resource Tracking, Needs & Costing Unit
UNAIDS
WHO staff
Dr Siobhan Crowley
Acting Coordinator
Anti-retroviral Treatment and HIV Care
Dr Chris Duncombe
Consultant
Antiretroviral Treatment and HIV Care
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25 Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents
25
World Health Organization
HIV/AIDS Department
20, Avenue Appia
1211 Geneva 27
Switzerland
hiv-aids@who.int
http://www.who.int/hiv