HIV/AIDS

Consolidated ARV guidelines 2013

Acknowledgements

Anthony Harries (International Union against Tuberculosis and Lung Disease, United Kingdom) and Gottfried Hirnschall (Department of HIV, World Health Organization) co-chaired the guidelines process.

Adult Guideline Development Group

Co-chairs: Serge Eholie (ANEPA/Treichville Hospital, Abidjan, Côte d’Ivoire) and Stefano Vella (Istituto Superiore di Sanità, Italy).

GRADE methodologist: Elie Akl (American University of Beirut, Lebanon).

Pedro Cahn (Fundación Huesped, Argentina), Alexandra Calmy (University of Geneva, Switzerland), Frank Chimbwandira (Ministry of Health, Malawi), David Cooper (University of New South Wales and St Vincent’s Hospital, Australia), Judith Currier (UCLA Clinical AIDS Research & Education Center, USA), François Dabis (School of Public Health (ISPED), University Bordeaux Segalen, France), Charles Flexner (Johns Hopkins University, USA), Beatriz Grinsztejn (Fundação Oswaldo Cruz (FIOCRUZ), Brazil), Diane Havlir (University of California at San Francisco, USA), Charles Holmes (Centre for Infectious Disease Research in Zambia, Zambia), John Idoko (National Agency for the Control of AIDS, Nigeria), Kebba Jobarteh (Centers for Disease Control and Prevention, Mozambique), Nagalingeswaran Kumarasamy (Y.R. Gaitonde Centre for AIDS Research and Education, India), Volodymyr Kurpita (All- Ukrainian Network of People Living with HIV, Ukraine), Karine Lacombe (Agence Nationale de Recherche sur le Sida et les Hépatites Virales (ANRS), France), Albert Mwango (Ministry of Health, Zambia), Leonardo Palombi (DREAM Program, Community of Sant’Egidio, Rome, Italy), Anton Pozniak (Chelsea and Westminster Hospital, United Kingdom), Luis Adrián Quiroz (Derechohabientes Viviendo con VIH del IMSS (DVIMSS), Mexico), Kiat Ruxrungtham (Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thailand), Michael Saag (University of Alabama at Birmingham, USA), Gisela Schneider (German Institute for Medical Mission, Germany), Yanri Subronto (Universitas Gadjah Mada, Indonesia) and Francois Venter (University of the Witwatersrand, South Africa).

Maternal and Child Health Guideline Development Group

Co-chairs: Abrams (International Center for AIDS Care and Treatment Programs (ICAP), Columbia University, USA) and Denis Tindyebwa (African Network for the Care of Children Affected by AIDS, Uganda).

GRADE methodologist: Joerg Meerpohl (German Cochrane Centre, University Medical Center, Freiburg, Germany).

Renaud Becquet (Internationale Institut de Santé Publique d’Epidémiologie et de Développement, Université Bordeaux Segalen, France), Deborah Birx (United States Centers for Disease Control and Prevention, USA), Benjamin Chi (Centre for Infectious Disease Research in Zambia, Zambia), Mark Cotton (Stellenbosch University, South Africa), Nonhlanhla Dlamini (National Department of Health, South Africa), René Ekpini (United Nations Children’s Fund, New York), Carlo Giaquinto (Paedatric Infectious Disease Unit and Clinical Trials Unit of Azienda Ospedaliera di Padua, Italy), Diana Gibb (Medical Research Council Clinical Trials Unit, United Kingdom), Sabrina Bakeera-Kitaka (Makerere University and Mulago National Referral Hospital, Uganda), Louise Kuhn (Columbia University, USA), Evgenia Maron (Charitable Women’s Foundation Astra, Russian Federation), Babalwa Mbono (mothers2mothers, South Africa), James McIntyre (University of Cape Town, South Africa), Lynne Mofenson (National Institutes of Health, USA), Angela Mushavi (Ministry of Health and Child Welfare, Zimbabwe), Ryan Phelps (United States Agency for International Development, USA), Jorge Pinto (Federal University of Minas Gerais, Brazil), Andrew Prendergast (Queen Mary University of London, United Kingdom), Thanyawee Puthanakit (Chulalongkorn University, Thailand), Atiene Sagay (Unversity of Jos, Nigeria), Roger Shapiro (Harvard School of Public Health, USA), George Siberry (National Institutes of Health, USA), Landry Tsague (United Nations Children’s Fund, Zambia), Thorkild Tylleskar (University of Bergen, Norway), Paula Vaz (Fundação Ariel Glaser contra o SIDA Pediátrico, Mozambique), Evgeny Voronin (Russian AIDS Pediatric Center, Russian Federation) and Linhong Wang (Chinese Center for Disease Control and Prevention, China).

Operational and Service Delivery Guideline Development Group

Co-chairs: Kevin De Cock (United States Centers for Disease Control and Prevention, USA) and Yogan Pillay (National Department of Health, South Africa).

GRADE methodologist: Holger Schünemann (Faculty of Health Sciences, McMaster University, Canada).

Tsitsi Mutasa Apollo (Ministry of Health and Child Welfare, Zimbabwe), Yibletal Assefa (Ministry of Health, Ethiopia), Paula Braitstein (Indiana University School of Medicine, USA), Zengani Chirwa (Ministry of Health, Malawi), Bui Duc Duong (Ministry of Health, Viet Nam), Ade Fakoya (Global Fund to Fight AIDS, Tuberculosis and Malaria, Switzerland), Robert Ferris (United States Agency for International Development, USA), Ronaldo Hallal (Departamento de DST, Aids e Hepatites Virais, Brazil), Eihab Ali Hassan (Federal Ministry of Health, Sudan), David Hoos (International Centre for AIDS Care and Treatment Programs, Columbia University, USA), Barbara Milani (Médecins Sans Frontières (MSF), Switzerland), Christine Nabiryo (The AIDS Support Organization (TASO), Uganda), Natalia Nizova (Ministry of Health, Ukraine), Anupam Pathni (International Planned Parenthood Federation South Asia, India), Elliot Raizes (United States Centers for Disease Control and Prevention, USA), Kenly Sekwese (Treatment Advocacy Literacy Campaign, Zambia), Larissa Stabinski (Office of the United States Global AIDS Coordinator, USA), Miriam Taegtmeyer (Liverpool School of Tropical Medicine, United Kingdom), Wim Van Damme (Institute of Tropical Medicine, Belgium), Eric van Praag (Family Health International (FHI), United Republic of Tanzania), Mean Chhi Vun (Ministry of Health, Cambodia), Larry Westerman (United States Centers for Disease Control and Prevention, USA), Steve Wignall (Clinton Health Access Initiative (CHAI), Indonesia) and Anna Zakowicz (Global Network of People Living with HIV (GNP+), Europe).

Programmatic Guideline Development Group

Co-chairs: Tsitsi Apollo (Ministry of Health and Child Welfare, Zimbabwe) and Adeeba Kamarulzaman (University of Malaya, Malaysia).

Ihab Abdelrahman (Ministry of Health and Population, Egypt), John Aberle-Grasse (United States Centers for Disease Control and Prevention, USA), Yibeltal Assefa (Ministry of Health, Ethiopia), Rob Baltussen (Radboud University Nijmegen, Netherlands), Anton Best (Ministry of Health, Barbados), John Blandford (United States Centers for Disease Control and Prevention, USA), Sergiy Filippovych (International HIV/AIDS Alliance in Ukraine, Ukraine), Eric Goemaere (Médecins Sans Frontières (MSF), South Africa), Dirceu Greco (Ministry of Health, Brazil), Timothy Hallett (Imperial College London, United Kingdom), Priscilla Idele (United Nations Children’s Fund, New York), Ushma Mehta (Independent Consultant, South Africa), Irene Mukui (National AIDS & STI Control Programme, Kenya), Jean Paul Moatti (French National Institute of Health and Medical Research (INSERM), Université de la Méditerranée, France), Natalia Nizova (Ministry of Health, Ukraine), Ole Frithjof Norheim (University of Bergen, Norway), Asia Russell (Health GAP, USA), Kenly Sikwese (Positive Health Outcomes, Zambia), Jerome Singh (Centre for the AIDS Programme of Research in South Africa, South Africa), Petchsri Sirinirund (Ministry of Public Health, Thailand), John Stover (Futures Institute, USA), Aliou Sylla (Ministry of Health, Mali), Wim Van Damme (Institute of Tropical Medicine, Belgium), Stefan Weinmann (Deutsche Gessellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Germany) and Annemarie M. J. Wensing (University Medical Centre Utrecht, Netherlands).

Observer at the Programmatic Guideline Development Group meeting: Bernhard Schwartländer (UNAIDS).

External peer reviewers

Michelle Adler (United States Centers for Disease Control and Prevention, USA), Isabelle Andrieux-Meyer (Médecins Sans Frontières, Switzerland), Xavier Anglaret (Programme PACCI du site ANRS de Côte d’Ivoire, Côte d’Ivoire), Marcelo Araujo de Freitas (Ministry of Health, Brazil), Pamela Bachanas (United States Centers for Disease Control and Prevention, USA), Shaiful Bahari Ismail (Universiti Sains Malaysia, Malaysia), Pierre Barker (University of North Carolina at Chapel Hill, USA), David Barr (HIV Collaborative Fund at Tides Center, USA), Jose Gerard Belimac (National AIDS and STI Prevention and Control Program, Philippines), Soumia Benchekroun (Centre Hospitalier Universaitaire Ibn Sina de Rabat, Morocco), Marc Bulterys (Chinese Centers for Disease Control and Prevention, China), Helen Bygrave (Médecins Sans Frontières, South Africa), Carlos F. Cáceres (Universidad Peruana Cayetano Heredia, Peru), Georgina Caswell (Global Network of People Living with HIV, South Africa), Alexander Chuykov (AIDS Healthcare Foundation, Russian Federation), Polly Clayden (HIV i-base, United Kingdom), Suzanne Crowe (Burnet Institute, USA), Margarett Davis (United States Centers for Disease Control and Prevention, USA), Chris Duncombe (Bill & Melinda Gates Foundation, USA), Marhoum El Filali (Ibn Rochd University Hospital, Morocco), Wafaa El-Sadr (International Center for AIDS Care and Treatment Programs, USA), Carlos Falistocco (SIDA y ETS del Ministerio de Salud de la Nación, Argentina), Donna Futterman (Children’s Hospital at Montefiore, USA), Elvin Geng (University of California at San Francisco, USA), Charles Gilks (University of Queensland, Australia), Giovanni Guidotti (DREAM Program, Community of Sant’Egidio, Italy), Bertrand Kampoer (Health consultant, Cameroon), Jonathan Kaplan (United States Centers for Disease Control and Prevention, USA), Sairankul Kassymbekova (National AIDS Center, Kazakhstan), Tamil Kendall (Trudeau Fondation, Mexico), Karusa Kiragu (UNAIDS), Emily Koumans (United States Centers for Disease Control and Prevention, USA), Richard Lester (University of British Columbia, Canada), Oyun Lkhagvasuren (Geneva Foundation for Medical Education and Research, Switzerland), Rangsima Lolekha (Ministry of Public Health, Thailand), Yolisa Mashologu (Human Sciences Research Council, South Africa), Edward Mills (University of Ottawa, Canada), Thomas Minior (United States Agency for International Development, USA), Julio Montaner (University of British Columbia, Canada), Lydia Mungherera (The AIDS Support Organization, Uganda), Joseph Murungu (Ministry of Health, Zimbabwe), Anthony Mutiti (Kitwe Central Hospital, Zambia), Jean Nachega (Johns Hopkins Bloomberg School of Public Health, USA), Steave Nemande (Alternatives-Cameroun, Cameroon), John Nkengasong (United States Centers for Disease Control and Prevention, USA), Siobhan O’Connor (United States Centers for Disease Control and Prevention, USA), Sylvia Ojoo (University of Maryland, USA), Nittaya Phanuphak (AIDS Research Centre, Thailand), Christian Pitter (Elizabeth Glaser Pediatric AIDS Foundation, USA), Praphan Pranuphak (Thai Red Cross AIDS Research Centre, Thailand), Helena Rabie (University of Cape Town and Stellenbosch University, South Africa), Gilles Raguin (GIP Esther, France), Peter Saranchuk (Médecins Sans Frontières, South Africa), Erik Schouten (Management Sciences for Health, Malawi), Jason Sigurdson (UNAIDS), Mariângela Simao (UNAIDS), Annette Sohn (TREAT Asia/ amfAR – Foundation for AIDS Research, Thailand), Luis Soto-Ramirez (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico), Wendy Stevens (National Health Laboratory Service, South Africa), Omar Sued (Fundacion Huésped, Argentina), Fatiha Terki (World Food Programme, Switzerland), Tengiz Tsertsvadze (Tbilisi State University, Georgia), Emilia Valadas (Clínica Universitária de Doenças Infecciosas e Parasitárias, Portugal), Helena Walkowiak (Management Sciences for Health, USA), Alice Welbourn (Salamander Trust, United Kingdom), Robin Wood (University of Cape Town, South Africa), Zhao Yan (Chinese Center for Disease Control and Prevention, China), Yazdan Yazdanpanah (Université Paris Diderot, France), José M. Zuniga (The International Association of Providers of AIDS Care, USA) and Sheryl Zwerski (National Institutes of Health, USA).

Contributors to the GRADE systematic reviews and supporting evidence

GRADE and evidence reviews: Isabelle Andrieux-Meyer (Médecins Sans Frontières, Switzerland), Andrew Anglemyer (University of California at San Francisco, USA), Till Barnighausen (Harvard School of Public Health, USA), Heiner Bucher (University Hospital Basel, Switzerland), Krista Chaivachati (Yale School of Medicine, USA), Larry Chang (Johns Hopkins University, USA), Tamara Credo (Medical Research Council, South Africa), Andrea De Luca (Azienda Ospedaliera Universitaria Senese, Italy), Didier Koumavi Ekouevi (PACCI Programme, France), Elvin Geng (University of California at San Francisco, USA), Tara Hovarth (University of California at San Francisco, USA), Andreas Jahn (Ministry of Health, Malawi), Alexander Kay (Stanford University, USA), Gail Kennedy (University of California at San Francisco, USA), Joy Oliver (South African Cochrane Centre, South Africa), Rosanna Peeling (London School of Hygiene and Tropical Medicine, United Kingdom), Martina Penazzato (WHO consultant, Switzerland), Heike Raatz (University Hospital Basel, Switzerland), George Rutherford (University of California at San Francisco, USA), Nandi Siegfried (University of California at San Francisco, USA), Alicen Spaulding (University of Minnesota, USA), Amitabh Suthar (WHO Consultant, Switzerland), Joseph Tucker (University of North Carolina School of Medicine, China), Gavrilah Wells (University of California at San Francisco, USA) and Zara Shubber (Imperial College London, United Kingdom).

Modelling work: Andrea Ciaranello (Massachusetts General Hospital, USA), Anne Cori (Imperial College London, United Kingdom), Mary-Ann Davies (University of Cape Town, South Africa), Jeffrey Eaton (Imperial College London, United Kingdom), Matthias Egger (University of Berne, Switzerland), Christophe Fraser (Imperial College London, United Kingdom), Timothy Hallett (Imperial College London, United Kingdom), Daniel Keebler (South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, South Africa), Nicolas Menzies (Harvard School of Public Health, USA), Paul Revill (University of York, United Kingdom), Michael Schomaker (University of Cape Town, South Africa), John Stover (Futures Institute, USA) and Peter Vickerman (London School of Hygiene and Tropical Medicine, United Kingdom).

Community values and preferences: Alice Kate Armstrong (Children’s HIV Association, South Africa), Laura Ferguson (Institute for Global Health, University of Southern California, USA), Adam Garner (Global Network of People Living with HIV, USA), Carolyn Green (International HIV/AIDS Alliance Associated Consultant, United Kingdom), Amy Hsieh (Global Network of People Living with HIV, USA), Nick Keeble (International HIV/AIDS Alliance, United Kingdom), Gitau Mburu (International HIV/AIDS Alliance, United Kingdom), Florence Ngobeni (Children’s HIV Association, South Africa), Mala Ram (International HIV/AIDS Alliance, United Kingdom), Anja Teltschik (International HIV/AIDS Alliance, United Kingdom) Robert Worthington (Kwantu, United Kingdom), and the WHO Civil Society Reference Groupi. Christoforos Mallouris (WHO consultant) provided coordination support for the community consultation work with the International HIV/AIDS Alliance and the Global Network of People Living with HIV.

WHO staff and consultants

Andrew Ball and Philippa Easterbrook (Department of HIV) coordinated the overall guideline development process with support from Cadi Irvine (Consultant, Department of HIV). The clinical and service delivery components of the guideline were supervised by Meg Doherty (Department of HIV), and the four Guideline Development Group work streams were facilitated by Eyerusalem Kebede Negussie (Operational and Service Delivery Guideline Development Group facilitator, Department of HIV), Lulu Muhe and Nathan Shaffer (Maternal and Child Health Guideline Development Group facilitators, Department of Maternal, Child and Adolescent Health and Department of HIV), Marco Vitoria (Adult Guideline Development Group facilitator, Department of HIV) and Joseph Perriëns (Programmatic Guideline Development Group facilitator, Department of HIV). The above group constitutes the WHO Guideline Steering Group.

A special thanks to the following WHO consultants who made major contributions to the writing and research for the guidelines: Jhoney Barcarolo (Guidance for Programme Managers), Shaffiq Essajee (Maternal and Child Health), Martina Penazzato (Maternal and Child Health) and Amitabh Suthar (Adult and Operational and Service Delivery). Ian Grubb provided overarching writing support and coordination of writing activities. David Breuer technically edited the text. The following WHO consultants were also involved in developing these guidelines: April Baller, Sally Girvin, Kathi Fox, Elizabeth Marum, Priya Shetty and Michelle Williams.

The following WHO staff members contributed to developing these guidelines: Rachel Baggaley (Department of HIV), Silvia Bertagnolio (Department of HIV), Jesus García Calleja (Department of HIV), Agnes Chetty (WHO Regional Office for the Eastern Mediterranean), Irina Eramova (WHO Regional Office for Europe), Nathan Ford (Department of HIV), Masami Fujita (WHO Regional Office for the Western Pacific), Haileyesus Getahun (Stop TB Department), Vincent Habiyambere (Department of HIV), Chika Hayashi (Department of HIV), Lali Khotenashvili, (WHO Regional Office for Europe), Ying-Ru Lo (WHO Regional Office for the Western Pacific), Frank Lule (WHO Regional Office for Africa), Viviana Mangiaterra (Department of Reproductive Health and Research), Hernan Julio Montenegro (Department of Health Policy, Development and Services), Lisa Nelson (Department of HIV), Morkor Newman (WHO Regional Office for Africa), Boniface Dongmo Nguimfack (Department of HIV), Linh Nguyen (Stop TB Department), Kevin O’Reilly (Department of HIV), Brian Pazvakavambwa (WHO Regional Office for Africa), Razia Pendse (WHO Regional Office for South-East Asia), Françoise Renaud-Théry (Department of HIV), Bharat B. Rewari (WHO Regional Office for South-East Asia), Nigel Rollins (Department of Maternal, Child and Adolescent Health), Anita Sands (Department of Essential Medicines and Health Products), Yves Souteyrand (WHO Regional Office for the Eastern Mediterranean), Isseu Diop Toure (WHO Regional Office for Africa), Annette Verster (Department of HIV), Gundo Weiler (Department of HIV) and Stefan Wiktor (Department of Pandemic and Epidemic Diseases). Supporting WHO interns include: Grace Akol, Hanna Yemane Berhane and Jayne Ellis.

WHO administrative support was led by Hayet Souissi and Jasmin Leuterio. Communication support was provided by Oyuntungalag Namjilsuren, Sarah Russell and Glenn Thomas. Maryann-Nnenkai Akpama, Afrah Al-Doori, Adriana De Putter, Lydia Mirembe Kawanguzi and Ophelia Riano provided additional administrative and management support.

Funders

Funding to support this work come from the United States Centers for Disease Control and Prevention, Bill & Melinda Gates Foundation, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), UNAIDS Unified Budget, Results and Accountability Framework, United States Agency for International Development and specific funds through WHO staff time. In addition, WHO is extremely thankful to the institutions that contributed staff time and other in-kind contributions to the guideline development process.


i WHO Civil Society Reference Group: Eddie Banda (Malawi Network of People Living with HIV/AIDS (MANET+), Malawi), Mabel Bianco (Fundación para el Estudio e Investigación de la Mujer (FEIM), Argentina), Tung Bui (Youth Voices Count, Thailand), Michaela Clayton (AIDS and Rights for Southern Africa, Namibia), Lee Hertel (International Network of People Who Use Drugs, USA), Ruth Mery Linares Hidalgo (Ciudad Quesada, Costa Rica), Noreen Huni (Regional Psychosocial Support Initiative (REPSSI), South Africa), Matthew Kavanagh (Health Gap, USA), JoAnne Keatley (University of California at San Francisco, USA), Sharonann Lynch (Doctors without Borders, USA), Babalwa Mbono (Mothers to Mothers (M2M), South Africa), Gitau Mburu (International HIV/AIDS Alliance, United Kingdom), Othoman Mellouk (orum on MSM and HIV, Morocco), Luís Mendão (European AIDS Treatment Group, Portugal), Noah Metheny (Global Forum on MSM and HIV, USA), Carlo Oliveras (Caribbean Treatment Action Group, Puerto Rico), Rachel Ong (Communities Delegation to the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Singapore), Asia Russell (Health Gap, USA), Leickness Simbayi (Human Sciences Research Council, South Africa), Felly Nkweto Simmonds (Population Council, Zambia), Lucy Stackpool-Moore (International Planned Parenthood Federation, United Kingdom), Ruth Morgan Thomas (Global Network of Sex Workers Projects, United Kingdom) and Mary Ann Torres (International Council of AIDS Service Organizations, Canada).

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