Reported in the special AIDS theme issue (July 10) of the Journal of the American Medical Association, the recommendations represent the consensus of a 17- member expert panel. The international panel of AIDS specialists was first convened in 1995 with the mission of developing treatment guidelines for health care practitioners, based on all information available. The panel has continued to develop recommendations around the four central issues in antiretroviral drug therapy: when to start therapy; what to start with; when to change therapy in the face of regimen failure; and what to change to. The last version was issued in January 2000.
Notable updates in the new recommendations include:
More data have emerged to support using the CD4 cell count as the primary indicator for when to start therapy. Previous guidelines used the plasma HIV RNA level (i.e., viral load) as a key laboratory indicator, but it now has less of a role in deciding when to start. Viral load remains an important marker of response to antiretroviral therapy.
Newer formulations of drugs and the availability/approval of new drugs have resulted in effective and more convenient regimens (e.g., once daily dosing regimens, smaller pill size, protease inhibitor "boosting" strategies, etc).
Designing a new regimen after treatment failure remains an important clinical issue. Viruses resistant to an increasing number of drugs raise challenges, both for the clinicians who need to design alternative regimens active on such viruses using their expertise as well as results from virus resistance testing, and for new drug discovery. Several new recently released drugs are
Contact: Annie Bayne
Columbia University Medical Center