PLHIV provide recommendations for revision of ART guidelines

This article originally appeared in HIV & AIDS treatment in practice, an email newsletter for healthcare workers and community-based organisations in resource-limited settings published by NAM between 2003 and 2014.
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During Summer 2009 GNP+ identified key recommendations for the revision of the World Health Organisation’s Recommendations for Antiretroviral Therapy (ART) for HIV Infection in Adults and Adolescents (ART Guidelines). In two technical consultations at the IAS 2009 Cape Town and ICAAP 2009 Bali conferences, as well as an e-consultation, people living with HIV discussed what they expect from their treatment programmes, what should be included in the coming ART Guidelines revision, and what should not be included.

Consultation participants recommend that the ART Guidelines should be based on the best scientific knowledge, and should recommend that treatment is initiated when CD4 cell counts fall below 350. However, people living with HIV must be able and empowered to make their own individual decisions about when to start and change treatment based on accurate information about treatment options, side-effects, drug resistance and co-infections. WHO guidelines should no longer recommend d4T but recommend tenofovir in its place.

In addition, PLHIV should have access to regular CD4 counts and periodic viral load tests (at least to confirm treatment failure before switching to second line). The role of resistance testing needs to be assessed in resource constrained settings.



Cost-effectiveness analyses compare the financial cost of providing health interventions with their health benefit in order to assess whether interventions provide value for money. As well as the cost of providing medical care now, analyses may take into account savings on future health spending (because a person’s health has improved) and the economic contribution a healthy person could make to society.

drug resistance

A drug-resistant HIV strain is one which is less susceptible to the effects of one or more anti-HIV drugs because of an accumulation of HIV mutations in its genotype. Resistance can be the result of a poor adherence to treatment or of transmission of an already resistant virus.

resistance testing

Laboratory testing to determine if an individual’s HIV strain is resistant to anti-HIV drugs. 

second-line treatment

The second preferred therapy for a particular condition, used after first-line treatment fails or if a person cannot tolerate first-line drugs.

treatment failure

Inability of a medical therapy to achieve the desired results. 

People living with HIV participating in the consultations agreed that their lives could be directly impacted by the revised ART Guidelines. However, they also noted that actual clinical practice was rarely up to the standards recommended by the ART Guidelines — including the treatment they themselves received. They highlighted the role of people living with HIV to use the ART guidelines as an advocacy tool, in ensuring that governments and funders see the long-term cost-effectiveness of starting treatment earlier and with better drugs.

Along with ITPC, ICW and Young Positives, GNP+ is continuing supporting of the ART Guidelines revision process, including the participation of people living with HIV in WHO meetings on the ART and PMTCT Guidelines in October 2009.

Click here to access the consultation reports:

Summary of Key Recommendations 60.50 Kb

Final Report of GNP+ Consultations on WHO ART Guidelines 667.46 Kb

Technical Consultation in partnership with APN+ at ICAAP 2009, Bali, August 2009 212.66 Kb

Technical Consultation in partnership with TAC at IAS 2009, Cape Town, July 2009 303.13 Kb

E-Consultation in partnership with NAM, July - August 2009 327.17 Kb