Managing Advanced HIV Disease in a Public Health Approach.
Managing Advanced HIV Disease in a Public Health Approach.
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DOI：
10.1093/cid/cix1139
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发表时间：
2018-03-04
期刊：
影响因子：
--
通讯作者：
Guideline Development Group for Managing Advanced HIV Disease and Rapid Initiation of Antiretroviral Therapy
中科院分区：
文献类型：
--
作者：
Ford N;Meintjes G;Calmy A;Bygrave H;Migone C;Vitoria M;Penazzato M;Vojnov L;Doherty M;Guideline Development Group for Managing Advanced HIV Disease and Rapid Initiation of Antiretroviral Therapy
2017年，世界卫生组织（WHO）发布了在公共卫生方法中管理晚期人类免疫缺陷病毒（HIV）疾病的指南。最近的数据表明，超过三分之一的人开始抗逆转录病毒治疗（ART）这样做与先进的艾滋病毒疾病，越来越多的病人重新出现在艾滋病毒疾病的晚期阶段后，一段时间脱离护理。这些指南根据发病率和死亡率的主要原因为成人、青少年和儿童推荐了一套标准化的护理方案：结核病、严重细菌感染、隐球菌脑膜炎、弓形虫病和肺孢子虫肺炎。根据最近2项随机试验的结果，建议采取一揽子有针对性的干预措施，以降低死亡率和发病率，这两项试验均显示，提供简化的干预措施可降低死亡率。考虑到这些结果和现有的建议，世卫组织建议向晚期艾滋病毒感染者提供一揽子护理;根据年龄和CD 4细胞计数，一揽子护理可能包括机会性感染筛查和预防，包括对隐球菌抗原阳性和无脑膜炎证据的人进行氟康唑预防治疗。还应向每一个晚期艾滋病毒感染者建议快速启动抗逆转录病毒治疗和加强依从性干预措施。
In 2017, the World Health Organization (WHO) published guidelines for the management of advanced human immunodeficiency virus (HIV) disease within a public health approach. Recent data suggest that more than a third of people starting antiretroviral therapy (ART) do so with advanced HIV disease, and an increasing number of patients re-present to care at an advanced stage of HIV disease following a period of disengagement from care. These guidelines recommend a standardized package of care for adults, adolescents, and children, based on the leading causes of morbidity and mortality: tuberculosis, severe bacterial infections, cryptococcal meningitis, toxoplasmosis, and Pneumocystis jirovecii pneumonia. A package of targeted interventions to reduce mortality and morbidity was recommended, based on results of 2 recent randomized trials that both showed a mortality reduction associated with delivery of a simplified intervention package. Taking these results and existing recommendations into consideration, WHO recommends that a package of care be offered to those presenting with advanced HIV disease; depending on age and CD4 cell count, the package may include opportunistic infection screening and prophylaxis, including fluconazole preemptive therapy for those who are cryptococcal antigen positive and without evidence of meningitis. Rapid ART initiation and intensified adherence interventions should also be proposed to everyone presenting with advanced HIV disease.
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