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Get on the fast-track. The life-cycle approach to HIV. Finding solutions for everyone at every stage of life.
Geneva, Switzerland, UNAIDS, 2016. 140 p.In this report, UNAIDS is announcing that 18.2 million people now have access to HIV treatment. The Fast-Track response is working. Increasing treatment coverage is reducing AIDS-related deaths among adults and children. But the life-cycle approach has to include more than just treatment. Tuberculosis (TB) remains among the commonest causes of illness and death among people living with HIV of all ages, causing about one third of AIDS-related deaths in 2015. These deaths could and should have been prevented. TB, like cervical cancer, hepatitis C and other major causes of illness and death among people living with HIV, is not always detected in HIV services. It is vital that we collaborate closely with other health programmes to prevent unnecessary deaths. The impact of better treatment coverage means that a growing number of people will be living with HIV into old age, while there has also been an increase in new HIV infections among older people. The consequences of long-term antiretroviral therapy, combined with the diseases of ageing, will be new territory for many HIV programmes. Drug resistance is a major threat to the AIDS response, not just for antiretroviral medicines but also for the antibiotic and antituberculous medicines that people living with HIV frequently need to remain healthy. More people than ever before are in need of second- and third-line medicines for HIV and TB. The human burden of drug resistance is already unacceptable; the financial costs will soon be unsustainable. We need to make sure the medicines we have today are put to best use, and accelerate and expand the search for new treatments, diagnostics, vaccines and an HIV cure. As we build on science and innovation we will need fresh thinking to get us over the remaining obstacles. The cliché is true -- what got us here, won’t get us there. We face persistent inequalities, the threat of fewer resources and a growing conspiracy of complacency. (Excerpt)
Antiretroviral therapy for HIV infection in infants and children: towards universal access. Recommendations for a public health approach.
Geneva, Switzerland, WHO, 2007.  p.These stand-alone treatment guidelines serve as a framework for selecting the most potent and feasible first-line and second-line ARV regimens as components of expanded national responses for the care of HIV-infected infants and children. Recommendations are provided on: diagnosing HIV infection in infants and children; when to start ART, including situations where severe HIV disease in children less than 18 months of age has been presumptively diagnosed; clinical and laboratory monitoring of ART; substitution of ARVs for toxicities. The guidelines consider ART in different situations, e.g. where infants and children are coinfected with HIV and TB or have been exposed to ARVs either for the prevention of MTCT (PMTCT) or because of breastfeeding from an HIV-infected mother on ART. They address the importance of nutrition in the HIV-infected child and of severe malnutrition in relation to the provision of ART. Adherence to therapy and viral resistance to ARVs are both discussed with reference to infants and children. A section on ART in adolescents briefly outlines key issues related to treatment in this age group. (excerpt)