Dr. Scott Hammer of NewYork-Presbyterian Hospital and Columbia University Medical Center has led the development of two important new guidelines for treatment of HIV.// He is lead author and chair of the panel of the International AIDS Society--USA's (IAS-USA) recommendations for treatment of the disease in developed nations—presented on Aug. 13 at the 2006 International AIDS Conference in Toronto and published in the Aug. 16 Journal of the American Medical Association (JAMA). And he is chairman of the writing committee of new guidelines published by the World Health Organization (WHO) for public health response to the disease in developing nations.
IAS-USA Guidelines for HIV Treatment in Developed Nations.
The IAS-USA guidelines, designed for individual patient management, reflect advances in treatment, simplifying regimens and reducing side effects. Recent advances include the development of a one-a-day combination pill and the ability to fully suppress HIV even in patients with the drug-resistant virus using protease inhibitors or the drug enfuvitide.
"These guidelines for treating HIV patients with antiretroviral therapy (ART) are important for clinicians worldwide given the rapid evolution of knowledge, the complexity of the field, and the varied clinical situations in which these agents are used," says Dr. Hammer, who is the Harold C. Neu Professor and chief of the Division of Infectious Diseases at Columbia University Medical Center and NewYork-Presbyterian. He is also professor of epidemiology at Columbia's Mailman School of Public Health.
In the nearly two decades since the advent of antiretroviral therapy for HIV, 21 new agents in five drug classes have been approved; potent combination therapy has become a worldwide standard of care; and morbidity and mortality in the developed world have been substantially reduced. Balanced against this progress is the identification of major unpredicted toxic effects and r
ecognition of the limitations that drug class cross-resistance place on alternate treatment regimens in the setting of treatment failure.
The 16-member IAS-USA panel was appointed based on expertise in HIV research and patient care internationally. More information is available at the IAS-USA Web site (http://www.iasusa.org).
WHO Guidelines for HIV Public Health Response in Developing Nations.
The WHO report, titled "Antiretroviral Therapy for HIV Infection in Adults and Adolescents in Resource-Limited Settings: Towards Universal Access," is an updated tool for public health efforts in the developing world, providing standard-of-care regimens to suppress HIV with ART. The guidelines, now in the third edition, provide a framework for increasing access to drugs and improved diagnostic tools.
"The WHO guidelines advocate for increased global access to drugs and treatment options, such as new drugs with less toxicity and regimens that promote adherence and health," says Dr. Hammer. "The recent and much-welcomed rapid scale-up of ART in resource-limited settings has necessitated a revision of the guidelines to keep them up-to-date."
By the end of 2005, the WHO estimated that there were just over 1.3 million people receiving ART in low-income and middle-income countries, representing 20 percent of the 6.5 million estimated to need it. In the last 25 years, AIDS has grown to pandemic proportions, resulting in 25 million deaths worldwide and an estimated 40 million people living with HIV.
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