1

|
World Health
Organization
Western Pacific Region
Antiretroviral therapy
in Asia and the Pacific
The 13
th
Philippine National Convention on AIDS,
24-25 October 2014, Manila, Philippines
HIV, Hepatitis and Sexually Transmitted Infections Unit
World Health Organization
Regional Office for the Western Pacific
2
|
World Health
Organization
Western Pacific Region
Presentation outline
Global picture
Regional progress on treatment
New WHO guidelines
Country examples
Conclusion
3
|
World Health
Organization
Western Pacific Region
Total: 35.0 million [33.2 million 37.2 million]
Middle East & North Africa
230 000
[160 000 330 000]
Sub-Saharan Africa
24.7 million
[23.5 million 26.1 million]
Eastern Europe &
Central Asia
1.1 million
[980 000 1.3 million]
Asia and the Pacific
4.8 million
[4.1 million 5.5 million]
North America and Western and Central Europe
2.3 million
[2.0 million 3.0 million]
Latin America
1.6 million
[1.4 million 2.1 million]
Caribbean
250 000
[230 000 280 000]
Global picture
Source UNAIDS
Adults and children estimated to be living with HIV2013
4
|
World Health
Organization
Western Pacific Region
Access to antiretroviral therapy (ART)
Source: 2014 Global AIDS Response Progress Reporting (WHO/UNICEF/UNAIDS).
12.9 million people on ART at the end of 2013
5
|
World Health
Organization
Western Pacific Region
Number of people receiving ART and percentage of all PLHIV on ART
in low- and middle-income countries (2013)
Source: 2014 Global AIDS Response Progress Reporting (WHO/UNICEF/UNAIDS).
6
|
World Health
Organization
Western Pacific Region
Source UNAIDS
Regional progress on treatment
7
|
World Health
Organization
Western Pacific Region
Source UNAIDS
Percentage of adults and children currently receiving ART
among PLHIV (2013)
8
|
World Health
Organization
Western Pacific Region
Regional progress on treatment
Paediatric treatment
Why new WHO guidelines in 2013?
Advances in science/technology and in vision
Technologies (incl. PoC CD4 and VL, new drug
formulations)
ART for individual and population benefits
HIV as a chronic health condition
Increasing focus on treatment adherence and retention
in care
Chronic care models decentralization, integration
Despite scale-up, continuing challenges
Low ART coverage among children, adolescents and
key populations
Major gaps in quality and in retention along the
continuum of care
Consolidated guidelines on the use of antiretroviral drugs
for treating and preventing HIV infection (2013)
10
|
World Health
Organization
Western Pacific Region
TOPIC 2002 2003 2006 2010
WHEN TO
START
CD4 200 CD4 200 CD4 200
- Consider 350
- CD4 350 for TB
CD4 350
-Irrespective CD4 for TB &
HBV
PMTCT Since 2001
4 weeks AZT; AZT+
3TC, or single
dose NVP
2004
AZT from 28
weeks
+ single dose
NVP
AZT from 28 weeks
+ single dose NVP
+AZT/3TC 7days
Option A
(AZT +infant NVP)
Option B
(triple ARVs)
1
ST
LINE 8 options
- AZT
preferred
4 options
- AZT preferred
8 options
- AZT or TDF
preferred
- d4T dose reduction
6 options & FDCs
- AZT or TDF preferred
- d4T phase out
2
ND
LINE Boosted PI Boosted PI Boosted PI
ATV/r, DRV/r, FPV/r
LPV/r, SQV/r
Boosted PI
Heat stable FDC: LPV/r,
ATV/r
VIRAL
LOAD
TESTING
No No
(Desirable)
Yes
Tertiary centers
Yes
Phase in
Evolution of WHO ART Guidelines
Earlier initiation
Simpler treatment
Safer, more robust regimens
Better monitoring
Simplified treatment options for pregnant women
Clinically relevant
o Earlier initiation of ART (CD4 500)
o Immediate ART for children below 5
years
o ART for all pregnant and breastfeeding
women with HIV (Option B/B+) and
lifelong ART (Option B+)
o Harmonization of ART across populations
(e.g., adults and pregnant women, B/B+)
and age groups
o Simplified, fewer, and less toxic 1
st
line
regimens (TDF/XTC/EFV)
New Recommendations in 2013 guidelines
Operationally relevant
oUse of Fixed Dose Combinations
as a preferred approach
oImproved patient monitoring to
support better adherence and
detect earlier treatment failure
(increased use of VL)
oRecommend task shifting,
decentralization, and integration
oCommunity based testing to
complement broader HTC
Consolidated guidelines on HIV prevention, diagnosis,
treatment and care for key populations (2014)
New recommendations
PrEP
Community based distribution of
naloxone
HIV and contraception
Drug interactions
13
|
World Health
Organization
Western Pacific Region
Adoption of New WHO 2013 Guidelines
Current Situation in the Region
Country
Revision of
National
guidelines
CD4500
All
children
<5 years
PMTCT
Option
B+
TDF/3TC_
FTC/EFV
as first
line
TDF/3TC_
FTC/EFV
for
PW/BF
women
Routine
VL
monitori
ng
Nurse
initiated
ART
Treatmen
t for
discordan
t couples
Cambodia in process
China in process X
Lao PDR in process
Mongolia X
PNG
Philippines X X X X
Viet Nam in process
14
|
World Health
Organization
Western Pacific Region
Cascade of HIV testing, care and treatment
WHO (July 2014)
15
|
World Health
Organization
Western Pacific Region
Antiretroviral-based prevention
16
|
World Health
Organization
Western Pacific Region
Conclusion
Significant progress on treatment coverage
New guidelines earlier treatment, standardized regimens,
treatment as prevention
Key population guidelines implication for the region
Cascade of testing, care and treatment
HIV testing
Diagnosis to care/treatment
Adherence/retention to care
17
|
World Health
Organization
Western Pacific Region
Thank you
Acknowledgements
Dr Ying-Ru Lo
Dr Dongbao Yu
Dr Pengfei Zhao
Ms Shweta Dhawan