The Guidelines for the Use of Antiretroviral Agents in HIV Infected Adults and Adolescents have been revised to include up-to-date treatment information, including new recommendations for resistance testing, treatment interruption, and HBV/HIV co-infection. The Guidelines, long considered the official guidebook to HIV treatment in the United States, have also been updated to include up-to-date information about drug interactions and about the new Kaletra (lopinavir/ritonavir) tablet formulation.
The revised Guidelines, released by the Department of Health and Human Services (HHS) on May 4th, include the following changes:
Resistance Testing Recommendation
The Guidelines now recommend performance of genotypic drug-resistance testing prior to initiation anti-HIV treatment in patients with acute or chronic HIV infection. Previously, the Guidelines recommended that resistance testing only be considered (not recommended) in chronically infected patients. Genotypic resistance testing may be considered in patients entering into care but not yet requiring therapy.
Treatment Interruption Recommendation
The Guidelines have completed revised its information on treatment interruptions to include: 1) recommendations for planned or unplanned short-term antiretroviral treatment interruption, such as when patients undergo elective surgeries or experience serious drug-related adverse reactions; and 2) discussions on the risks and benefits of planned long-term antiretroviral treatment interruption in chronically infected patients with viral suppression.
Recent data from two prospective trials showed a higher incidence of HIV disease progression and death in patients who discontinued therapy when T-cell counts rose above 350 and who restarted when T-cell counts fell below 250 (see our February 14th story on this). The Guidelines also emphasize the need for more controlled clinical trials, using other strategies, to address the risks and benefits of treatment interruption.
The Guidelines caution patients and clinicians that treatment interruption should only be done in the setting of a clinical trial and under close observation.
Hepatitis B/HIV Coinfection
The revised Guidelines also include updated information on the management of patients with hepatitis B and HIV coinfection.
Changes to the document are summarized in the "What's New in the Document?" section, and all changes to the document are highlighted in yellow throughout the text.
The updated Guidelines document is available in the ADULT GUIDELINES section of the HHS AIDSinfo web site. The site also contains an option to order hard copies of the guidelines or request an electronic copy by e-mail.
AIDSinfo is also a useful source of other information related to HIV/AIDS, including other treatment and prevention guidelines, downloadable databases for PDAs (personal digital assistants), and HIV/AIDS-related clinical trials information.
Source:
Department of Health and Human Services (HHS)
