Experts Advise Antiretrovirals for All HIV-Infected Patients
New recommendations include ART, regardless of CD4 count; regimen switching as necessary
MONDAY, July 23 (HealthDay News) -- Based on recent data, current recommendations suggest that all patients infected with HIV should be treated with antiretroviral therapy (ART), according to research published in the July 25 issue of the Journal of the American Medical Association, a theme issue on HIV/AIDS, to coincide with the International AIDS Conference, held from July 22 to 27 in Washington, D.C.
Melanie A. Thompson, M.D., from the AIDS Research Consortium of Atlanta, and colleagues reviewed recent data published or presented in the last two years to update guidelines on ART for HIV-infected adults in resource-rich settings.
The researchers recommended ART for all adults with HIV-infection. With decreasing CD4 count and the presence of specific concurrent conditions, the strength of the recommendation and quality of the evidence increased. Initial regimens should include two nucleoside reverse transcriptase inhibitors plus a non-nucleoside reverse transcriptase inhibitor, a ritonavir-boosted protease inhibitor, or an integrase strand transfer inhibitor. In each class, alternatives are recommended for patients with or at risk of certain comorbidities. CD4 count, HIV-1 RNA level, engagement in care, ART adherence, HIV drug resistance, and quality-of-care indicators should all be monitored. Virologic, immunologic, or clinical failure and drug toxicity or intolerance represent reasons for regimen switching.
"New recommendations for HIV patient care include offering ART to all patients regardless of CD4 cell count, changes in therapeutic options, and modifications in the timing and choice of ART in the setting of opportunistic illnesses," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry. The study was funded by the International Antiviral Society-USA, which receives funding from pharmaceutical companies.