GUIDELINES GUIDELINE ON WHEN TO START …

1 GUIDELINE ON when TO START antiretroviral therapy AND ON PRE-EXPOSURE PROPHYLAXIS FOR HIV SEPTEMBER 2015 GUIDELINESThis early-release GUIDELINE will form part of the revised updated WHO consolidated GUIDELINES on the use of antiretroviral drugs for treating and preventing HIV infection due to be published in ON when TO START antiretroviral therapy AND ON PRE-EXPOSURE PROPHYLAXIS FOR HIV SEPTEMBER 2015 WHO Library Cataloguing-in-Publication DataGuideline on when to START antiretroviral therapy and on pre-exposure prophylaxis for Infections drug therapy .

2 Agents administration and dosage. agents therapeutic use. Health 978 92 4 150956 5 (NLM classification: WC ) World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO website ( ) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: Requests for permission to reproduce or translate WHO publications whether for sale or for non-commercial distribution should be addressed to WHO Press through the WHO website ( ).)

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5 Printed in SwitzerlandGuideline on when to START antiretroviral therapy and on pre-exposure prophylaxis for HIV5 Abbreviations and acronyms 6 Definition of key terms 7 Acknowledgements 9 Executive summary 12 Summary of new recommendations 13 1. Introduction 16 Health sector response to HIV 16 Objectives 16 Target audience 17 Guiding principles 17 Methods for developing the GUIDELINES Competing interests GUIDELINE contributors Methods for evidence synthesis Peer review 212.

6 Recommendations 24 when to START antiretroviral therapy when to START ART among adults (>19 years old) when to START ART among pregnant and breastfeeding women when to START ART among adolescents (10 19 years of age) when to START ART among children (younger than 10 years of age) 38 Oral pre-exposure prophylaxis for preventing the acquisition of HIV infection 42 Programmatic note on the recommendations 503. Publication, dissemination and evaluation 54 References 55 Annex 1.

7 Declaration of interests, Clinical GUIDELINE Development Group, June 2015 68 Annex 2. Evidence to decision-making tables and supporting evidence (available in web annex)CONTENTSC ontentsContents6 GUIDELINE on when to START antiretroviral therapy and on pre exposure prophylaxis for HIVABBREVIATIONS AND ACRONYMSAIDS acquired immunodeficiency syndromeART antiretroviral therapyARV antiretroviralFTC emtricitabineGRADE grading of recommendations, assessment, development and evaluationHIV human immunodeficiency virusPICO population, intervention.

8 Comparison and outcomePMTCT prevention of mother-to-child HIV transmissionPrEP pre-exposure prophylaxisTB tuberculosisTDF tenofovir disoproxil fumarateUNAIDS Joint United Nations Programme on HIV/AIDSWHO World Health Organization7 GeneralHIV refers to the human immunodeficiency virus. There are two types of HIV: HIV-1 and is responsible for the vast majority of HIV infections groups and populationsThe following definitions for adults, adolescents, children and infants are used to ensure consistency within these GUIDELINES .

9 Other agencies may use different definitions. An adult is a person older than 19 years. An adolescent is a person 10 19 years old inclusive. A child is a person younger than 10 years old. An infant is a child younger than one year of couples are couples in which one partner is living with HIV and the other is HIV-negative. A couple refers to two people in an ongoing sexual relationship; each of these people is referred to as a partner in the relationship. How individuals define their relationships will vary according to their cultural and social populations are groups that have a disproportionate burden of HIV in many settings.

10 They frequently face legal and social challenges that increase their vulnerability to HIV, including barriers to accessing HIV prevention and treatment. Key populations include (1) men who have sex with men, (2) people who inject drugs, (3) people in prisons and closed settings, (4) sex workers and (5) transgender populations are populations that are vulnerable to HIV in certain situations or contexts, such as adolescents (particularly adolescent girls in sub-Saharan Africa), orphans, people with disabilities and migrant and mobile workers.