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Challenges and priorities in the management of HIV/HBV and HIV/HCV coinfection in resource-limited settings.
Seminars In Liver Disease. 2012 May; 32(2):147-57.Liver disease due to chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is now emerging as an increasing cause of morbidity and mortality in human immunodeficiency virus- (HIV-) infected persons in resource-limited settings (RLS). Existing management guidelines have generally focused on care in tertiary level facilities in developed countries. Less than half of low-income countries have guidance, and in those that do, there are important omissions or disparities in recommendations. There are multiple challenges to delivery of effective hepatitis care in RLS, but the most important remains the limited access to antiviral drugs and diagnostic tests. In 2010, the World Health Assembly adopted a resolution calling for a comprehensive approach for the prevention, control, and management of viral hepatitis. We describe activities at the World Health Organization (WHO) in three key areas: the establishment of a global hepatitis Program and interim strategy; steps toward the development of global guidance on management of coinfection for RLS; and the WHO prequalification program of HBV and HCV diagnostic assays. We highlight key research gaps and the importance of applying the lessons learned from the public health scale-up of ART to hepatitis care. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Hopkins HIV Report. 2002 Jul;  p..The WHO guidelines are based on rigorous evaluation of data collected almost exclusively in developed countries. Of concern is whether guidelines created for HIV-infected populations of developed nations are adaptable to HIV-infected populations worldwide. Specifics regarding the presence of different HIV subtypes, endemic infections such as tuberculosis, genetic determinants, and other health measures such as nutritional status may introduce factors that alter response to treatment. Developing nations that have successfully implemented HAART include Brazil, Thailand, Senegal, and Uganda. Studies are needed to examine responses to HAART and whether changes to the guidelines would better serve populations in different regions around the world. For example, initiation of HAART earlier in the course of HIV disease may have an impact on disease outcomes due to endemic mycobacterial infections such as tuberculosis. With initiation of HAART on a population-wide scale, continuous surveillance of drug-resistant HIV will be needed to update treatment guidelines. A recent study conducted in Gabon demonstrated resistance to antiretroviral therapy. Of great concern is that antiviral drug resistance due to suboptimal therapies could limit the potency of available treatments. (excerpt)
Geneva, Switzerland, WHO, 2004.  p.Influenza vaccines and antiviral drugs for influenza are essential components of a comprehensive pandemic response, which also includes planning for antibiotic supplies and other health care resources. However, the current reality is that most countries have no or very limited supplies. Such a situation would force national authorities to make difficult decisions concerning which citizens should receive first call on limited vaccines and drugs. This document provides guidance to health policy-makers and national authorities on planning principles and options for the prioritization of vaccine and antiviral use during an influenza pandemic. It includes recommendations on actions that can improve future supply for the many countries that currently have no national vaccine or antiviral production. (excerpt)
Bulletin of the World Health Organization. 2003 Oct; 81(10):776.At a special session of the United Nations General Assembly in New York on 22 September, WHO declared the failure to expand access to antiretrovirals in the developing world a global health emergency. The announcement was made together with UNAIDS and the Global Fund to Fight AIDS, Tuberculosis & Malaria. (excerpt)