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) World Wide 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 were constructed as a "living document" and 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," says Anthony S. Fauci, M.D., 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."
The updated Guidelines are available at www.hivatis in two formats, a typeset version (PDF) and a Web version (HTML). Single copies can be ordered by calling 1-800-448-0440 (international callers may call 1-301-519-0459), or by sending an e-mail request to firstname.lastname@example.org.
The updated Guidelines include recommendations for the use in clinical practice of recently developed tests that help determine if the virus a patient is carrying has developed resistance 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," says John G. Bartlett, M.D., 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 Guidelines 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 in order to preserve future treatment options utilizing drug resistance assays when treatment fails.
The Panel also has 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 an HIV-infected individual's quality of life. 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.
Co-conveners of the Panel on Clinical Practices for the Treatment of HIV Infection are Eric Goosby, M.D., on behalf of the Department of Health and Human Services, and Jennifer Kates, M.A, M.P.A., on behalf of the Henry J. Kaiser Family Foundation. Oren J. Cohen, M.D., NIAID Assistant Director for Medical Affairs, serves as the Panel's Executive Secretary.
NIAID is a component of the National Institutes of Health (NIH). NIAID conducts and supports research to prevent, diagnose and treat illnesses such as HIV disease and other sexually transmitted diseases, tuberculosis, malaria, asthma and allergies. NIH is an agency of the U.S. Department of Health and Human Services.
The Henry J. Kaiser Family Foundation, based in Menlo Park, CA, is an independent philanthropy focusing on the major health care issues facing the nation. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.
Press releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at www.niaid.nih.gov. HIV-related information is also available on the Kaiser Family Foundation Web site at www.kff.org/sections.cgi?section=hivaids.