Revised HIV treatment guidelines issued recently by US and international health officials emphasize initiating antiretroviral (ARV) therapy earlier. A growing body of clinical evidence suggests that earlier therapy reduces HIV-related illnesses and deaths, and it "may also decrease inflammation and immune activation thought to contribute to higher rates of cardiovascular and other comorbidities reported in HIV-infected cohorts," according to the US Department of Health and Human Services' (HHS) revised "Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents."
Adult and adolescent patients should begin ARVs if their CD4 count is below 350 cells/cubic millimeter, and the therapy is "recommended" for those with higher counts of 350-500 cells/cubic millimeter, the expert panel recommended. More than half the panel members rated the strength of the recommendation as strong, while the remainder categorized it as moderate.
For patients with CD4 counts above 500 cells/cubic millimeter, half the panel recommended starting ARVs, and half viewed treatment as "optional." Pregnant women, people with HIV-associated kidney disease and those co-infected with hepatitis B should begin treatment regardless of CD4 count, the panel said.
In addition, raltegravir (Isentress) has been moved to the "preferred" list of first-line HIV drugs. Efavirenz (Sustiva), ritonavir-boosted atazanavir (Reyataz), and boosted darunavir (Prezista) are the other three options preferred in combination with tenofovir plus emtricitabine (Truvada). The lopinavir/ritonavir combination pill (Kaletra) is now designated an "alternative."
For more information, visit http://aidsinfo.nih.gov/contentfiles/adultandAdolescentGL.pdf.
12/03/09
UNITED STATES: US and WHO Guidelines Call for Earlier HIV Treatment
Source: Bay Area Reporter (San Francisco):: Liz Highleyman; Courtesy of the CDC National Center for HIV, STD, and TB Prevention