Updated HIV Treatment Guidelines

The Panel on Clinical Practices for Treatment of HIV regularly reviews and updates its recommendations on when to initiate treatment of those people living with HIV. Included in the recommendations are preferred regimens, methods of evaluating the effectiveness of therapies, and goals of therapy. Here is a summary of The Panel's most current recommendations.

When Should Treatment be Initiated?

• Antiretroviral therapy is recommended for all patients with AIDS defining illnesses or symptomatic HIV infection regardless of CD4 count or HIV Viral Load.

• Antiretroviral therapy is recommended for asymptomatic patients with a CD4 count < 200.

• Those asymptomatic patients with CD4 counts of 201 - 350 should be offered treatment.

• Most experienced clinicians will defer treatment for those asymptomatic patients with CD4 counts > 350 and viral loads > 100,000.

• HIV Treatment should be deferred for those patients with a CD4 count > 350 and a viral load of < 100,000.

Which Regimens are Preferred Initial Therapies?

• The Panel recommends that an initial regimen contain two nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) and either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a ritonavir-boosted or unboosted protease inhibitor (PI).

Which Drug Combinations Should Not Be Used?

• Drugs that are very similar (e.g. Epivir and Emtriva) should not be used together.

• Drugs that have additive toxicity (e.g. Zerit and Videx) should not be used together.

• Those drugs that have the potential for interactions (e.g. Retrovir and Zerit) should not be used together.

_{These recommendations were developed by the Panel on Clinical Practices for the Treatment of HIV Infection, October 2004.}