The New Joint Guide for the Use of Antiretroviral Treatments in Resource Limited Settings Presented Today

' - TINTERNATIONAL
SOCIETY
PRESS RELEASE
DURBAN, 12TFI JULY 2000
THE NEW JOINT GUIDE FOR THE USE OF
ANTIRETROVIRAL TREATMENTS IN RESOURCE LIMITED
SETTINGS PRESENTED TODAY
There is just one standard of care worldwide. Low and middle-income countries
have requested recommendations for the provision and monitoring of
antiretroviral therapy that are more directly relevant to their resource limited
settings than the published International guidelines. To respond to such a topical
issue, the International AIDS Society (IAS), WHO and UNAIDS have issued a
new guide which provides feasible solutions.
The new guide uses an evidence-based approach considering that HIV/AIDS care
should address a broad range of needs: patients in advanced stage of disease, limited
resource settings, barriers to adherence including setting-related ones, issues of
counseling and disclosures etc.
The guide defines some essential conditions that must be satisfied before starting
programs with antiretroviral therapy (ART): assured access to voluntary HIV counseling
and testing; capacity to recognize and manage HIV-related illnesses and opportunistic -U
infections; reliable laboratory monitoring services; assurance an of adequate supply of -o
drugs, sufficient resources to pay for treatments on a long-term basis and the __
-o
establishment of reliable regulatory mechanisms against misuse and misappropriation of -
the drugs.
This guide is unique in the emphasis that is put on counseling and psychosocial support
as an essential component of ART. Counseling should address five main issues: financial
considerations, drug information, emotional support, issues of disclosure (confidentiality
and sharing HIV status) and adherence to treatment.
Clinical and laboratory assessments are described, indicating those that are essential for
evaluation before initiating ART.
Whenever possible, criteria for initiating ART should be developed at National level. In
resource limited settings, where the conditions necessary for the initiation of ART
programs have been fulfilled, priority to treatment should be given to symptomatic
patients with severe immune damage (i.e. CD4 count below 200 cells/mm), because
these patients are at a high risk for disease progression.

The guide indicates that there is only one standard of treatment, which is the use of a
combination of drugs aimed at maximal suppression of viral replication.