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Update on the June 6 and 7, 2012 WHO Treatment Optimization Diagnostics Workstream meeting

Update on the June 6 and 7, 2012 WHO Treatment Optimization Diagnostics Workstream meeting. Joseph Perriëns World Health Organization Geneva. LABORATORY MONITORING OF ART IN ADULTS WHO 2010 "GUIDING PRINCIPLES".

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Update on the June 6 and 7, 2012 WHO Treatment Optimization Diagnostics Workstream meeting

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  1. Update on the June 6 and 7, 2012 WHO Treatment Optimization Diagnostics Workstreammeeting Joseph Perriëns World Health Organization Geneva

  2. LABORATORY MONITORING OF ART IN ADULTS WHO 2010 "GUIDING PRINCIPLES" These recommendations are being re-assessed as part of the development of WHO's 2013 consolidated guidelines on ART Laboratory monitoring is not a prerequisite for the initiation of ART. CD4 and viral load testing are not essential for monitoring patients on ART. Symptom-directed laboratory monitoring for safety and toxicity is recommended for those on ART. If resources permit, use viral load in a targeted approach to confirm suspected treatment failure based on immunological and/or clinical criteria. If resources permit, use viral load in a routine approach, measured every 6 months, with the objective of detecting failure earlier than would be the case if immunological and/or clinical criteria were used to define failure. International AIDS Conference 2012

  3. DIAGNOSIS OF HIV INFECTION AND MONITORING ART IN INFANTS AND YOUNG CHILDREN – WHO 2010 These recommendations are being re-assessed as part of the development of WHO's 2013 consolidated guidelines on ART It is strongly recommended that all HIV-exposed infants have HIV virological testing at 4 – 6 weeks of age or at the earliest opportunity thereafter. The following assays (and respective specimen types) are strongly recommended for use: HIV DNA on whole blood specimen or DBS, HIV RNA on plasma or DBS, Up24 Ag on plasma or DBS. "Exercise caution in interpreting negative results when using HIV RNA or Up24 if infant is established on ART." In infants with an initial positive virological test result, it is strongly recommended that …/…a second specimen be collected to confirm the initial positive virological test result. HIV VL measurement in monitoring treatment: "As required or symptom directed" International AIDS Conference 2012

  4. Objectives of the meeting To articulate consensus on technologies which need to be deployed nowin HIV programs To identify which technologies need to be developed in short, medium and longer term International AIDS Conference 2012

  5. Technology deployment levels InternationalAIDS Conference 2012

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  9. Viral load and Early diagnosis in infants (EID) • Short term needs • POC EID and VL testsfor use in health centre/office and first referral lab settings • Medium/longer term needs • Instrument free POC test for use in community • Combo tests (CD4/VL) • Semi-automated devices for deployment at level 2 and up. International AIDS Conference 2012

  10. HIV Drug Resistance 7/19/2012 Mention of any product or manufacturer in this presentation should not be interpreted as their endorsement by WHO International AIDS Conference 2012

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  12. Medium and longer term needs • Combo tests (CD4/VL) • Home sample collection tools International AIDS Conference 2012

  13. Acknowledgements International AIDS Conference 2012

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