HIV/AIDS Treatment and Care

Clinical protocols for the WHO European Region

23 November 2007

World AIDS Day

Jeffrey V. Lazarus

WHO Europe, STI/HIV/AIDS Programme

Annual number of newly reported cases – all WHO EURO countries

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

110,000

120,000

HIV AIDS AIDS Deaths

* Preliminary and incomplete data

WHO/UNAIDS estimates, end of 2007:PLHIV: 2,360,000 (1.8–3.2m)

Number of cases reported to WHO, end 2006:New HIV infections: 1 012 820 New AIDS cases: 327 068New AIDS deaths: 177 641

Newly reported HIV cases, 19892006

010,00020,00030,00040,00050,00060,00070,00080,00090,000

100,000

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

010,00020,000

30,00040,00050,00060,00070,000

80,00090,000

100,000

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

010,00020,00030,00040,00050,00060,00070,00080,00090,000

100,000

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

HIV cases: 458 215AIDS cases: 287 589AIDS deaths: 159 974

HIV cases: 503 766AIDS cases: 23 606AIDS deaths: 10 134

HIV cases: 26 922AIDS cases: 15 873AIDS deaths: 7 533

Policy framework

Universal access by 2010 to HIV/AIDS prevention, treatment, care and support, 2006

Global STI Strategy Dublin Declaration on Partnership to fight

HIV/AIDS in Europe and central Asia (2004) Global Health Sector Strategy for HIV/AIDS,

2003 UNAIDS/WHO “3 by 5” Initiative UNGASS Declaration, 2001 Millennium Development Goals, 2000 Regional WHO resolutions

5 pillars for UA by 2010

1. Enabling people to know their HIV status through confidential HIV testing and counselling

2: Maximizing the health sector's contribution to HIV prevention

3: Accelerating the scale-up of HIV/AIDS treatment and care

4: Strengthening and expanding health systems

5: Investing in strategic information to guide a more effective response

How WHO is working with countries to scale up HIV prevention, treatment, care and support: http://www.who.int/hiv/toronto2006/towardsuniversalaccess.pdf

HIV/AIDS Treatment and Care protocols for CIS countries

Developed and published in March 2004 Rationale

– Scale up access to treatment and care– Availability of funds (GFTAM, WB)– Similar health care systems– No guidance at country level on provision of

comprehensive HIV/AIDS treatment and care Background for developing National Protocols

Process and progress

Series of technical consultations– HIV/AIDS Clinical Staging and AIDS case

definition (May 24-26, Copenhagen)– Sexual and reproductive health for PLHIV (June

1-3, Stresa, Italy)– HIV/Hepatitis co-infection (June 9-11, Lisbon)– HIV/AIDS treatment for IDUs (June 13-15,

Lisbon)– Vaccination of PLHIV(June, Copenhagen)

Identified gaps

Clinical management of HIV/Hepatitis co-infection

Sexual and reproductive health for PLHIV Vaccination of PLHIV PMTCT for female IDUs

Identified chaptersto be improved

HIV/AIDS treatment and care for IDUs Management of TB/HIV co-infection HIV testing and counselling ART for adults

The result: 13 protocolsEdited by Irina Eramova, Srdan Matic, Monique Munz

1. Patient evaluation and antiretroviral treatment for adults and adolescents

2. Management of opportunistic infections and general symptoms of HIV/AIDS

3. Palliative care for people living with HIV/AIDS 4. Management of tuberculosis and HIV coinfection 5. HIV/AIDS treatment and care for injecting drug users 6. Management of hepatitis C and HIV coinfection 7. Management of hepatitis B and HIV coinfection 8. Prevention of hepatitis A, B and C and other hepatotoxic factors in

people living with HIV/AIDS 9. Support for sexual and reproductive health in people living with

HIV/AIDS 10. Prevention of HIV transmission from HIV-infected mothers to their

infants 11. Paediatric HIV&AIDS treatment and care 12. Immunization of people living with HIV/AIDS and people at risk of

HIV infection 13. Post-exposure prophylaxis for HIV infection

Advocacy and strategic informationwww.euro.who.int/aids

The goal