HIV: Government updates patient treatment protocol – 10/20/2023 – Health

After a six-year hiatus, the Ministry of Health updated the PCDT (Clinical Protocol and Therapeutic Guidelines) for adults living with HIV/AIDS). The launch took place at the 23rd Brazilian Congress of Infectious Diseases, held in Salvador, but the ordinance was published this Friday (20), by the Secretariat of Science, Technology, Innovation and Strategic Inputs in Health.

One of the novelties of the new version involves antiretrovirals — the incorporation into the SUS (Unified Health System) of a simplified regimen in a single daily tablet with lamivudine and dolutegravir.

The combination should be available at the beginning of 2024. Until then, it remains the preferred initial antiretroviral treatment used since 2018, which consists of two daily tablets: one with tenofovir fumarate co-formulated with lamivudine and the other with dolutegravir.

The combination of lamivudine and dolutegravir had already been approved by Anvisa (National Health Surveillance Agency) since 2021, but the incorporation into the SUS only occurred this year. Clinical studies have shown effectiveness in controlling HIV, including fewer side effects.

The new formulation is an emerging strategy that will help in the treatment of those suffering from the effects of prolonged use of the treatment, such as the elderly and those with kidney and bone problems.

“People are getting older with HIV. There are more than 250,000 people over the age of 50 on treatment. Many have high blood pressure, diabetes, kidney disease. In this sense, it is a strategy aimed at this specific population, within the Brazilian reality” , explains infectologist Ronaldo Hallal, technical advisor to the General Coordination of Surveillance of HIV/Aids and Viral Hepatitis of the Ministry of Health and coordinator of updating the document.

The single pill is one of several strategies offered. According to Hallal, tenofovir will remain in the protocol, as well as other medications that may be used depending on the patient and the clinical situation.

“Recommendations have been published that allow individualizing the initiation of treatment, the management of HIV resistance, for people who develop tuberculosis, for people who are aging and for those who develop adverse effects of treatment”, he highlighted.

For infectologist Rico Vasconcelos, a researcher at the USP Faculty of Medicine, the simplification of the antiretroviral regimen is one of the positive points of the new protocol.

“Leaving just two antiretrovirals and removing the one that has the greatest potential for toxicity due to its long-term use, which is tenofovir, is something that the whole world is doing. With lamivudine and dolutegravir, we will be able to carry out the treatment whole with one tablet once a day, with enormous potential for maintaining virus control and lower toxicity”, he comments.

Another gain in the protocol, according to Vasconcelos, is the official incorporation of modern diagnostic tests for opportunistic diseases, such as tuberculosis, cryptococcosis and histoplasmosis.

The new protocol has three axes. According to Hallal, the first involves approaching and welcoming the patient, in addition to a social perspective.

“The first module brings the central aspects of antiretroviral treatment, the health professional’s management when approaching the person living with HIV and AIDS; the approach to sexuality, reproduction planning; the importance of acceptance and bonding; recommendations for immediate start of treatment and treatment schedules and laboratory tests”, he stated.

A specific chapter addresses guidelines for situations where treatment is interrupted, establishing the schemes for restarting it.

The second axis talks about the safest and most effective treatments for co-infections and opportunistic infections such as tuberculosis, viral hepatitis, syphilis, HTLV (human T-cell lymphotropic virus), Chagas disease, meningitis, among other problems that affect people living with HIV /Aids.

“Today we still have AIDS as a public health problem and AIDS mortality that has not reduced in recent years. The protocol gives recommendations on how to use new tests, for example, for tracking and diagnosing tuberculosis and clearer notions of rapid onset , preferably up to seven days, of HIV treatment combined with international guidelines, such as those from the World Health Organization”, says infectious disease specialist Hallal.

The third axis, which deals with addressing non-communicable comorbidities — such as diabetes and hypertension, for example — and managing the adverse effects of treatment on people living with HIV, will be scheduled for 2024.

Prejudice is still identified as a barrier, especially for the most vulnerable populations in Brazil.

“We have lived through four years in which prejudice, homophobia, transphobia and racism were brought into the picture by governments and opinion makers. The United Nations recommends that one of the goals to eliminate HIV should be zero discrimination — prejudice, discrimination, low income, poverty, lack of access, all of this represents a barrier for people to seek testing, because they suffer a second discrimination, which is having HIV and AIDS”, said the infectious disease specialist.

The reporter traveled at the invitation of the Brazilian Society of Infectious Diseases.