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WHO updates provisional guidelines on HIV treatment

WHO updates provisional guidelines on HIV treatment

Updated guidelines on first-and second-line treatment, post-exposure prophylaxis, and early infant diagnosis of HIV.

Following are the major recommendations:

  • A DTG-based regimen may be recommended as a preferred first-line treatment for:
  • adults and adolescents (moderate-certainty evidence).
  • women and adolescent girls during the periconception period (very low-certainty evidence); should be used cautiously.
  • Infants and children with approved DTG dosing (low-certainty evidence).
  • A RAL-based regimen may be recommended as:
  • Alternative first-line regimen to infants and children for whom approved DTG dosing is not available (low-certainty evidence).
  • Preferred first-line regimen for neonates (very low-certainty evidence).
  • DTG has been found to be effective for pregnant women and has been found in breast-milk, resulting in significant plasma concentration in infants; hence it may reduce the mother-to-child transmission of HIV infection.
  • The needs and perceptions of women, their families and communities are central to providing care and implementing programmes and services. A woman-centered approach is supported by 2 guiding principles, promoting human rights and gender equality.
  • DTG in combination with an optimized nucleoside reverse-transcriptase inhibitor may be recommended as a preferred second-line treatment in adults with HIV (moderate-certainty evidence) and in children with approved DTG dosing (low-certainty evidence) who failed to respond to non-DTG-based regimens (moderate-certainty evidence).
  • The HIV post-exposure prophylaxis regimen with 2 ARV drugs is effective in adults and adolescent and children, but 3 drugs should be preferred as follows:
  • DTG is recommended should be preferred as a third drug (low-certainty evidence).
  • When available, atazanavir/ritonavir, darunavir/ritonavir, lopinavir/ritonavir, and RAL may be considered as alternative third drug options (low-certainty evidence).
  • An indeterminate range should be used to improve the accuracy of all nucleic acid-based early infant diagnosis assays.

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Source: With inputs from WHO

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