Magazine article Drug Topics

Early Antiretroviral Therapy for HIV Advised in New Guidelines

Magazine article Drug Topics

Early Antiretroviral Therapy for HIV Advised in New Guidelines

Article excerpt

Antiretroviral therapy (ART) should be offered to all patients as soon as possible, regardless of CD4 cell count, because earlier ART may lead to improved outcomes, according to new recommendations presented during AIDS 2012, the 19th International AIDS Conference, held in Washington, D.C. The new guidelines, published online July 25 in JAMA: The Journal of the American Medical Association, include recommendations on changes in therapeutic options and modifications in the timing and choice of ART in the setting of opportunistic illnesses.

Improvements and updates

Melanie Thompson, MD, of the AIDS Research Consortium of Atlanta, headed the panel that developed the 2012 Recommendations of the International Antiviral Society-USA Panel (IAS -USA). Thompson and her colleagues systematically reviewed the literature on treatment outcomes over the past 2 years to assess guidelines and provide current recommendations that take into account improvements in the potency tolerability simplicity and availability of ART.

This revision of the International Antiviral (formerly AIDS) Society-USA (IAS -USA) guidelines reflects new data informing consideration of when to initiate ART, new options for initial and subsequent therapy, ART management in the setting of special conditions, and new approaches to monitoring treatment success and quality," the authors wrote.

According to the panel, evidence indicates that ART reduces the likelihood of HIV transmission while providing clinical benefit to treated individuals.

"The concentration of HIV in both blood and seminal plasma correlates with the probability of transmission of HTV to a sexual partner. Reducing levels of HTV with ART decreases the probability of transmission, as confirmed in the HPTN 052 study, in which ART was 96% effective in reducing HTV transmission," the authors stated.

Therapy can be offered, regardless of CD4 cell count, as long as a patient is ready and willing to adhere to the regimen. "Clinicians should engage supportive services as needed to assist with ART education and to address barriers to adherence," the authors wrote.

Initial recommendations

The initial recommended regimens include two nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine or abacavir/lamivudine) plus a nonnudeoside reverse transcriptase inhibitor (efavirenz), a ritonavir-boosted protease inhibitor (atazanavir or darunavir), or an integrase strand transfer inhibitor (raltegravir). …

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