US DHHS Revised Adult HIV Treatment Guidelines

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On October 10, 2006, the DHHS Panel on Antiretroviral Guidelines for Adults and

Adolescents released a new revision of the Guidelines for the Use of

Antiretroviral Agents in HIV-1-Infected Adults and Adolescents.

The following are among changes that have been made to the May 4, 2006 version

of the guidelines:

* The Panel confirms that the regimens with the most experience in demonstrating

virologic and immunologic efficacy are those composed of 1 NNRTI + 2 NRTI or of

a PI (with or without ritonavir boosting) + 2 NRTI. The Panel also confirms that

the selection of an antiretroviral regimen should be individualized, based on

patient- and drug-specific factors.

* The Panel revised its recommendations for preferred and alternative

antiretroviral components based on reported results from several randomized

trials in treatment-naïve patients and on safety data that have emerged since

the last revision. Specific recommendations can be found in Tables 6a

(http://aidsinfo.nih.gov/ContentFiles/TB6a_AdultandAdolescentGL.pdf

<http://aidsinfo.nih.gov/ContentFiles/TB6a_AdultandAdolescentGL.pdf> ) and 6b

(http://aidsinfo.nih.gov/ContentFiles/TB6b_AdultandAdolescentGL.pdf

<http://aidsinfo.nih.gov/ContentFiles/TB6b_AdultandAdolescentGL.pdf> ).

Rationale for the recommendations is outlined in the text.

The following tables have been updated:

* Table 6 has been revised and divided into Tables 6a and 6b to reflect the

above revisions.

* Tables 7 and 9 have been updated to reflect changes in the recommendations.

* Table 10 has been updated with results from several recently published

clinical trials.

* Tables 11-13, 15, and 17-19 have been updated to include information regarding

darunavir and the fixed-dose combination of efavirenz/emtricitabine/ tenofovir

(Atripla) and new safety information and black box warnings regarding rare

cases of intracranial hemorrhages occurring in patients receiving tipranavir.

* Tables 20-22b have been updated to include darunavir drug-drug interactions.

* Tables 28 and 29 have been revised according to updates in the Perinatal

Guidelines to incorporate preclinical and clinical data relevant to the use of

darunavir during pregnancy and new recommendations on antiretroviral use during

pregnancy.

* Table 30 has been updated to include information on expanded access programs

for two investigational

agents, TMC125 and MK-0518.

The complete October 10, 2006, version of the adult treatment guidelines is

available on the AIDSinfo web site at

http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf

<http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf> . Changes will

be found highlighted in yellow.

Usha Sharma PhD MPH

Division of AIDS,

Prevention Sciences Branch

National Institute of Allergy and Infectious Diseases,

Bethesda, MD 20892-7628

E-MAIL: <USharma@...>