HIV Department, World Health Organization, Geneva, Switzerland.
J Int AIDS Soc. 2013 Jun 30;16(1):18757. doi: 10.7448/IAS.16.1.18757.
The 2013 World Health Organization's (WHO) Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection provide more than 50 new recommendations across the continuum of HIV care, including recommendations on HIV testing, using antiretroviral drugs for prevention, linking individuals to HIV care and treatment services, initiating and maintaining antiretroviral therapy (ART) and monitoring treatment. Guidance is provided across all age groups and populations of adults, pregnant and breastfeeding women, adolescents and key populations. The guidelines are based on a public health approach to expanding the use of ARV drugs for HIV treatment and prevention, with a particular focus on resource-limited settings. The most important new clinical recommendations include: treating adults, adolescents and older children earlier - starting ART in all individuals with a CD4 cell count of 500 cells/mm(3) or less (but giving priority to those with advanced clinical disease or a CD4 cell count less than 350 cells/mm(3)); starting ART at any CD4 cell count in certain populations, including those with active TB (existing recommendation), Hepatitis B infection and severe chronic liver disease, HIV-positive partners in serodiscordant couples (existing recommendation), pregnant and breastfeeding women, and children younger than 5 years of age; a preferred first-line ART regimen of Tenofovir+3TC or FTC+ Efavirenz as a once-daily fixed-dose combination for adults, pregnant women, and children aged 3 years and older; and the use of viral load testing as the preferred approach to monitoring the response to ART and to diagnose treatment failure. Guidance is also provided on enhancing the efficiency and effectiveness of HIV services, including strategies to improve retention in care, and adherence to ART; task-shifting to address human resource gaps; decentralizing delivery of ART to primary health care, and integrating ART services within maternal and child health, TB or drug dependency clinics. There is additional guidance for programme managers on how to plan HIV programmes and use resources most efficiently.
2013 年世界卫生组织（WHO）的《使用抗逆转录病毒药物治疗和预防 HIV 感染的综合指南》为 HIV 护理的连续体提供了 50 多项新建议，包括 HIV 检测、预防使用抗逆转录病毒药物、将个人与 HIV 护理和治疗服务联系起来、启动和维持抗逆转录病毒治疗（ART）以及监测治疗的建议。指南适用于所有年龄段和成年人群体、孕妇和哺乳期妇女、青少年和重点人群。该指南基于扩大抗逆转录病毒药物用于 HIV 治疗和预防的公共卫生方法，特别关注资源有限的环境。最重要的新临床建议包括：更早地治疗成人、青少年和大龄儿童——在所有 CD4 细胞计数为 500 个/立方毫米或更低的个体中开始 ART（但优先考虑那些有晚期临床疾病或 CD4 细胞计数低于 350 个/立方毫米的个体）；在某些人群中，包括患有活动性结核病（现有建议）、乙型肝炎感染和严重慢性肝病、血清不一致的伴侣中 HIV 阳性的个体（现有建议）、孕妇和哺乳期妇女以及年龄小于 5 岁的儿童，开始在任何 CD4 细胞计数时开始 ART；将替诺福韦+拉米夫定或替诺福韦+依非韦伦作为每日一次的固定剂量组合，作为成人、孕妇和 3 岁及以上儿童的首选一线 ART 方案；以及使用病毒载量检测作为监测 ART 反应和诊断治疗失败的首选方法。还提供了关于提高 HIV 服务的效率和效果的指南，包括改善护理保留和 ART 依从性的策略；解决人力资源差距的任务转移；将 ART 服务下放到基层医疗保健，并将其整合到母婴健康、结核病或药物依赖诊所中。还为方案管理人员提供了关于如何最有效地规划 HIV 方案和使用资源的额外指导。
