NCJ Number
190438
Date Published
2001
Length
108 pages
Annotation
These guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents were developed by the Panel on Clinical Practices for Treatment of HIV Infection convened by the U.S. Department of Health and Human Services and the Henry J. Kaiser Family Foundation.
Abstract
The availability of an increasing number of antiretroviral agents and the rapid evolution of new information has introduced extraordinary complexity into the treatment of HIV-infected persons. This report recommends that care should be supervised by an expert, and it offers recommendations for laboratory monitoring, including plasma HIV RNA, CD4 cell counts, and HIV drug resistance testing. The report also provides guidelines for antiretroviral therapy, including when to start treatment, what drugs to initiate, when to change therapy, and therapeutic options when changing therapy. Special considerations are provided for adolescents and pregnant women. Regarding specific recommendations, treatment should be offered to all patients with the acute HIV syndrome, those within 6 months of HIV seroconversion, and all patients with symptoms ascribed to HIV infection. Recommendations for offering antiretroviral therapy in asymptomatic patients require analysis of many real and potential risks and benefits. In general, treatment should be offered to individuals with fewer than 350 CD4+ T cells/mm3 or plasma HIV RNA levels that exceed 30,000 copies/mL (bDNA assay) or 55,000 copies/mL (RT-PCR assay). Once the decision has been made to initiate antiretroviral therapy, the goals should be maximal and durable suppression of viral load, restoration and/or presentation of immunologic function, improvement in quality of life, and reduction of HIV-related morbidity and mortality. Optimal changes in therapy may be especially difficult to achieve for patients in whom the preferred regimen has failed, due to limitations in the available alternative antiretroviral regimens that have documented efficacy; these decisions are further confounded by problems with adherence, toxicity, and resistance. In some settings, it may be preferable to participate in a clinical trial with or without access to new drugs or to use a regimen that may not achieve complete suppression of viral replication. 23 tables, 1 figure, and 184 references