prevention technologies include condoms, lubricants, sterile injection equipment, antiretroviral medicines (e.g. to prevent mother-to-child transmission or as postexposure prophylaxis) and, once developed, safe and effective microbicides and vaccines. Based on human rights principles, universal access requires that these goods, services and information not only be available, acceptable and of good quality, but also within physical reach and affordable for all.104 114. The Inter-American Commission notes that HIV/AIDS can be effectively and indefinitely treated via administration of antiretroviral drugs,105 which improve and enhance the quality of life of persons infected with HIV.106 Said treatment is delicate, and both its initiation and follow-up must be carried out by suitably qualified staff, bearing in mind the circumstances of the person infected with HIV.107 Stopping the treatment would lead to a revival of the symptoms and an earlier death.108 The Pan American Health Organization has provided particular parameters that should be followed prior to initiating antiretroviral treatment.109 115. Notwithstanding, according to the Guideline 6 suitable HIV/AIDS treatment requires not only access to antiretroviral medicine on a permanent basis, but also consistent periodical follow-up that not only includes medical aspects, but also adequate nutrition, psychological support for the day-to-day and social activities of life.110 116. Along the same lines and taking into account the variety of sources, the Inter-American Court recently held that: Access to antiretroviral drugs is only one of the elements of an effective response to persons living with HIV. In this regard, persons living with HIV require a comprehensive approach that includes a continuum of prevention, treatment, care and support. A limited response to access to antiretroviral drugs and other medicines does not fulfill the obligations of prevention, treatment, care and support emanating from the right to the highest possible level of health.111 104 IA Court of HR. Case of Gonzales Lluy et al v. Ecuador. Preliminary Objections, Merits, Reparations and Costs. Judgment of September 01, 2015. Series C No. 298. Par. 196. Quoting: OUNHCHR and UNAIDS, International Guidelines on HIV/AIDS and Human Rights. Consolidated Version of 2006, comment on Guideline 6, par. 26. Available at: http://data.unaids.org/pub/Report/2006/jc1252internationalguidelines_es.pdf. 105 IACHR, Report No. 63/08, Case 12.534, Admissibility and Merits, Andrea Mortlock, United States, July 25, 2008, par. 90. 106 IACHR, Report No. 27/09, Case 12.249, Jorge Odir Miranda Cortez et al, El Salvador, March 20, 2009, par. 104. 107 IACHR, Report No. 27/09, Case 12.249, Jorge Odir Miranda Cortez et al, El Salvador, March 20, 2009, par. 104. 108 IACHR, Report No. 63/08, Case 12.534, Admissibility and Merits, Andrea Mortlock, United States, July 25, 2008, par. 90. Prior to beginning antiretroviral therapy, the clinician must make sure that the following has been done: - Clinical history and physical exploration.. – Confirmation of diagnosis of HIV infection (according to local protocols). Whenever possible, it is best for this to be done with two Elisa tests using two different techniques in two different samples and with confirmation of test result in one of the samples. – Comprehensive blood work. – Biochemical blood profile, including glucose, bilirubin, transaminase, amylase (when using DDI), creatinine or BUN, cholesterol, triglycerides and partial urine test. – CD4 cell count, using flow cytometry or another equivalent reliable method. – When available, viral load when the CD4 cell count is lower than 350 cells/mm3. – Nutritional situation and eating habits. – Evaluation of mental, psychological, emotional, family, work and social factors of the patient, which may positively or negatively affect future adherence, to care services and to any potential treatment that he or she may receive, especially antiretroviral treatment.” PAHO, “HIV/AIDS: PAHO prepares a guide to increase use of antiretroviral drugs in Latin America and the Caribbean,” Press Release January 10, 2003. 109 110 Office of the United Nations High Commissioner for Human Rights (UNHCHR) and the Joint United Nations Program on HIV/AIDS (UNAIDS), International Guidelines on HIV/AIDs and Human Rights. Consolidated Version of 2006, Guideline 6. Available at: http://data.unaids.org/pub/Report/2006/jc1252-internationalguidelines_es.pdf. 111 IA Court of HR. Case of Gonzales Lluy et al v. Ecuador. Preliminary Objections, Merits, Reparations and Costs. Judgment of September 01, 2015. Series C No. 298. Par. 197. Also quoting: The Guidelines also establish that “States should also ensure access to adequate treatment and drugs, within the overall context of their public health policies, so that people living with HIV can live as long and 30