HIV Guidelines Urge Closer Monitoring

A new set of HIV guidelines urges closer and more personalized monitoring of drug adherence, entry to care, and retention in care.

The 37 recommendations arise from the first effort at synthesizing existing evidence in order to provide clinical guidance for HIV caregivers, according to Melanie Thompson, MD, of the AIDS Research Consortium of Atlanta, and colleagues.

"All of the data have never really been looked at before with an eye toward making recommendations that could be clinically helpful to people," Thompson told MedPage Today.

A key aspect of the guidelines, appearing online in Annals of Internal Medicine, is an emphasis in individualized care, she said.

"HIV is a complex disease in and of itself, but many people with HIV have complex lives," she said. Interventions "really have to be personalized, because every patient brings different issues to the table. There really isn't a one-size-fits-all answer."

The guidelines were developed by a panel convened by the International Association of Physicians in AIDS Care and were originally intended to deal mainly with questions of adherence to anti-retroviral drugs, Thompson said.

The World Health Organization (WHO) has developed guidance for health care workers on how to support children up to 12 years of age and their caregivers with disclosure of HIV status. Health care workers (HCWs) know that disclosure decisions are complex because of stigma, social support concerns, family relations, parenting skills and concern about children's emotional and maturational ability to understand and cope with the nature of the illness. HCWs challenged by the complicated issues facing HIV-affected families are often without the support of definitive, evidence-based policies and guidelines on when, how, and under what conditions children should be informed about their own or their caregivers' HIV status. Consequently, many health care workers around the world are uncertain how to counsel clients about the disclosure process. Thus, they may often miss opportunities to assist parents in dealing with these issues and explaining to parents the need for HIV testing and counselling for all their children. The lack of disclosure ultimately adversely affects the well-being of the child, including access to paediatric HIV treatment and care and adherence to treatment.

This guidance is intended as part of a comprehensive approach to ensuring child wellbeing-that is, the physical, emotional, cognitive and social well-being of the developing child-following the child's own diagnoses of HIV or that of a parent or close caregiver.
Disclosure is crucial to the continuum of HIV care.

But the mandate expanded, she said, with the realization that many patients were not entering or staying in care, so that the question of drug adherence could not even arise.

Of the three areas, Thompson said, "Monitoring retention in care is probably key."