Issues in medicine : the 2010 South African guidelines for the management of HIV and AIDS

Abstract

The South African (SA) National Department of Health (DoH) released new guidelines for the management of HIV/AIDS in April 2010. We discuss here controversial issues and operational challenges in the guidelines; the stimulation of debate and contributing to future guidelines; the timing of initiation of antiretroviral treatment, scope and timing of laboratory monitoring and testing of concomitant conditions, operational challenges such as paediatric HIV treatment and nurse-driven care, and procedures relating to the guidelines such as the need for transparency of the guideline committee and the standard of evidence used to develop the guidelines. We welcome comment and sharing of further insights that will contribute to future guidelines. Our motivation stems from the facts that South Africa’s HIV epidemic is not abating; its Millennium Development Goals are not being met; and child and maternal mortality are worse than they were in 1990.1 The Department of Virology of the University of Pretoria convened a meeting of private and public health practitioners in June 2010 to debate the DoH’s new antiretroviral treatment (ART) guidelines.