Updated Treatment Guidelines for Adult HIV

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IAC: Updated Treatment Guidelines for Adult HIV

August 15, 2006 (Reuters Health) - The International AIDS Society-USA Panel has

released guidelines updating its treatment recommendations for adult HIV

infection, according to a report in the August 16th issue of the Journal of the

American Medical Association.

Lead author Dr. M. Hammer, from Columbia University in New York, presented

the " consensus of a 17-member panel " on Sunday at a JAMA media briefing held at

the International AIDS Conference in Toronto.

According to the report, the International AIDS Society-USA Panel has updated

its HIV treatment guidelines seven times since 1996, the last being in 2004.

The current update was generated by a panel of individuals who were appointed

based on expertise in HIV research and patient care. In creating the guidelines,

the group evaluated data published or presented from mid 2004 to May 2006. The

focus was on data that could actually alter the 2004 guidelines.

" We focused on the four classic questions of antiretroviral therapy: when to

start; what to start with; when to change -- because of toxicity or poor

response -- and what to change to, " Dr. Hammer said.

The guidelines continue to recommend starting antiretroviral therapy in all

symptomatic patients and in asymptomatic patients whose CD4+ cell count has

dropped below 350/µL and has not yet fallen below 200/µL, the researchers state.

The initial drug regimen should include either a nonnucleoside reverse

transcriptase inhibitor or a protease inhibitor boosted with low-dose ritonavir.

In addition, the patients should receive two nucleoside reverse transcriptase

inhibitors.

A change in therapy should occur whenever toxic effects or intolerance require

it. Such a change is also indicated in cases of documented treatment failure.

What agent to change to depends on the reason for the change, the authors note.

If the change is due to toxic effects that can be clearly linked to a particular

agent, a single-drug substitution may suffice. Stopping all drugs and

reevaluating the situation may be necessary if the toxicity cannot be tied to

just one drug.

If the reason for change is treatment failure, then what to change to depends on

whether it is a first or multiple regimen failure. With either type of failure,

however, the goal is to make a change that ensures at least two active agents

are included in the regimen.

" Perhaps the biggest single issue that separates these guidelines from the past

is the redefinement of the goal of therapy in treatment-experienced individuals

-- particularly highly experienced individuals, " Dr. Hammer said. " In the past,

we were satisfied to drop viral load by half aa log to a log and to maintain

immunologic and clinical benefits, " he said. Now a fair amount of individuals

can achieve undetectable viral levels, even patients with triple class

experience.

" Given the rapid evolution of knowledge, clinicians are challenged to stay

abreast of new information that can affect practice, " the authors conclude.

" Therapeutic choices rooted in the pathogenesis of HIV disease and

individualization of therapy to maximize benefit are the principles that remain

constant in a rapidly changing environment. "

Sourse:-

http://www.poz.com/articles/761_10036.shtml

______________________________

Tarit Chakraborty(PresidentBNP+)

Regional Coordinatore INP+(Eastern region)

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