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AIDS: Group Offers Guideline Updates for HIV Management

Items cover initiation of antiretrovirals, choosing first regimen, handling treatment failure

MONDAY, Aug. 4 (HealthDay News) -- Updated guidelines for antiretroviral therapy in adult HIV infection from the International AIDS Society-USA offer recommendations for starting therapy, choosing an initial regimen and other vital issues, and are published in the Aug. 6 issue of the Journal of the American Medical Association and presented at AIDS 2008, the International AIDS Conference held Aug. 3 to 8 in Mexico City.

Scott M. Hammer, M.D., of the Columbia University College of Physicians and Surgeons in New York City, and colleagues recommend therapy in asymptomatic patients before their CD4 cell count falls below 350/μL. Factors that should be considered in such individuals include patient willingness, comorbidities and risk of disease progression.

The initial regimen will typically include two nucleoside reverse transcriptase inhibitors plus efavirenz or a ritonavir-boosted protease inhibitor, the authors note. Clinicians should aim to reduce and control plasma HIV-1 RNA to less than 50 copies/mL, and levels should be checked frequently after initiating treatment or changing it for virologic failure until levels fall below assay detection limits, the authors write. Once viral load is suppressed over a lengthy period and CD4 counts are holding at 350/μL or more, biannual CD4 counts are appropriate.

"The 21 years since zidovudine was approved for the treatment of HIV infection have witnessed …a dynamic drug development process that has led to the current availability of more than 30 individual drugs and fixed-dose combinations to treat HIV infection," the authors write. "Despite these advances, disease management remains challenged by toxicities, maintenance of adherence, clinical manifestations related to both the drugs and the HIV infection itself, and the threat of drug resistance."

Hammer and most of the co-authors disclosed financial relationships with a variety of pharmaceutical companies.

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