AIDS is one of the major public health issues affecting human health, and standardized diagnosis and treatment are crucial for improving patient prognosis and quality of life. Under the leadership of Professor Li Taisheng, the Director of the Chinese Society of Infectious Diseases, Chinese Medical Association and the Director of the Department of Infectious Diseases at PUMCH, the AIDS taskforce of the Chinese Society of Infectious Diseases, after nearly a year’s painstaking preparation and revision, finally officially released the “Chinese Guidelines for Diagnosis and Treatment of Human Immunodeficiency Virus Infection/Acquired Immunodeficiency Syndrome (2024 Edition)” (hereinafter referred to as the Guidelines).

The 2024 edition of the Guidelines covers 14 aspects, including AIDS-related tumors, prevention of mother-to-child transmission of HIV and reproduction for HIV discordant couples, pre- and post-exposure prophylaxis of HIV, and whole-process management of HIV infection. A big part of the Guidelines is the updating of key aspects, including antiretroviral therapy (ART), opportunistic infections, HIV and tumors combined, prevention and intervention of HIV infection, and whole-process management. The Guidelines added a new chapter on “incomplete immune reconstitution in AIDS patients” and introduced the concept of “population vulnerable to AIDs” for the first time, further broadening the theoretical and practical basis for AIDS diagnosis and treatment. The document also added 49 recommendations on diagnosis and treatment, each with supporting evidence for and strength of the recommendation.

To inform early diagnosis of HIV infection, the new Guidelines specified a threshold of 1,000 copies/mL for nucleic acid testing for the first time domestically and internationally, providing a more precise basis for clinical judgment. The new Guidelines emphasizes that ART is recommended to start as early as possible for all HIV-infected individuals regardless of CD4+ T lymphocyte levels to reduce morbidity and mortality. If possible, patients are recommended to initiate ART rapidly (within 7 days of diagnosis) or on the same day of diagnosis. Regarding monitoring of antiviral treatment, the new Guidelines introduced the concepts of “blips” (transient elevations of viral load following a period of undetectable HIV RNA) and “LLV” (low-level viremia) and their clinical management for the first time. The new Guidelines also proposed diagnostic criteria and clinical management measures for incomplete immune reconstitution in AIDS patients for the first time.

The 2024 edition of the Guidelines has substantially updated and revised the five aspects of whole-process management, recommending it for all HIV-infected individuals. It introduced the concept of “population vulnerable to AIDs” for the first time, which mainly include patients over 50 years old, pediatric patients, pregnant women, late presenters, patients with multiple underlying diseases, patients with severe immunosuppression such as those with a CD4+ T lymphocyte count <50/μL, and patients with incomplete immune reconstitution after ART. For these patients, more aggressive use of ART, proactive treatment of underlying diseases, and multidisciplinary collaboration are warranted.

▲Group photo of experts attending the finalization meeting for the "Chinese Guidelines for Diagnosis and Treatment of Human Immunodeficiency Virus Infection/Acquired Immunodeficiency Syndrome (2024 Edition)"

Link to the Guidelines: https://rs.yiigle.com/cmaid/1501644

Written by Shen Yinzhong (Shanghai Public Health Clinical Center) and Li Taisheng

Pictures courtesy of the Department of Infectious Diseases

Translated by Liu Haiyan

Reviewed by Wang Yao