March 2000
BETHESDA, MD. - An updated version of the Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents has been posted to the HIV/AIDS Treatment Information Service (ATIS) Web site, www.hivatis.org.
The guidelines were developed by the Panel on Clinical Practices for the Treatment of HIV Infection, a joint effort of the Department of Health and Human Services and the Henry J. Kaiser Family Foundation. Initially published in 1998, the guidelines are updated frequently by the panel as new data emerge.
"The number of treatment options for HIV-infected individuals has increased dramatically, making decisions regarding therapy more and more complex," said Anthony S. Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases (NIAID) and co-chair of the panel. "The new guidelines, based on the latest available research findings, provide recommendations on how to optimally use the many antiretroviral medications and sophisticated laboratory tests now available to people living with HIV."
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The updated guidelines include recommendations for the use in clinical practice of recently developed tests that help determine whether the patient has a strain that is resistant to one or more antiretroviral drugs.
"These tests can help to explain the reasons for treatment failure and guide the rational selection of a new drug regimen," said John G. Bartlett, MD, chief of the division of infectious diseases at the Johns Hopkins University Medical Center and co-chair of the panel. "The likelihood of reducing viral load to undetectable levels is significantly increased when results of resistance testing are available to guide the selection of a new drug regimen for patients who are not doing well on their current regimens."
The updated guidelines also contain a new section entitled "The Goals of Therapy." In addition to reiterating the goal of suppressing plasma viral load to below detectable levels for as long as possible, the panel recognizes that eradication of HIV infection is probably not possible with currently available treatments and emphasizes the need to think strategically about antiretroviral therapy.
In this regard, the updated guidelines discuss other primary goals of antiretroviral therapy, including restoration and/or preservation of the patient's immunologic function, improvement of their quality of life, reduction of HIV-related illness and death.
The new guidelines also delineate tools that may help achieve these goals, including:
Maximizing patient adherence to a regimen;
Selecting "user-friendly" regimens when possible;
Prescribing drugs in a rational sequence to preserve future treatment options; and,
Using drug-resistance assays when treatment fails.
The panel has also reorganized its recommendations for the use of antiretroviral drugs in the initial therapy of HIV infection. Previously, drugs were placed in the "Preferred" category on the basis of their ability to suppress plasma viral load. In keeping with the newly elaborated goals of therapy, considerations such as pill burden, dosing frequency, food requirements, convenience, toxicity and drug interaction profiles underpin the new recommendations.
The updated guidelines "Strongly Recommended" category now includes a small number of drugs the Panel feels can accomplish many therapeutic goals with minimal negative effects on the quality of life of someone infected with HIV. Other potent drugs that can also suppress plasma viral load but do so at a high cost to quality of life are now included under the heading "Recommended as Alternatives."
Finally, a new hypertext link to detailed information on the use of antiretroviral drugs in pregnant women has been added. This information will help physicians select the most appropriate antiretroviral regimen for their HIV-infected patients who are pregnant.
The updated guidelines are available in two formats, a typeset version (PDF) and a Web version (HTML). Single copies can be ordered by calling (800) 448-0440 (international callers, (301) 519-0459), or by sending an e-mail request to atis@hivatis.org.
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