US guidelines updated – November 2008

The US Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents were updated in November.

  • Changes for treatment naive patients include:
    • adding darunavir/r as a preferred PI;
    • moving once-daily lopinavir/r from alternative to preferred PI (except for pregnant women);
    • moving abacavir+3TC from a preferred to an alternative dual-NRTI because of concerns regarding an increased risk of myocardial infarction in patients with high cardiac risk factors, and virologic potency with baseline viral loads>100,000 copies/mL;
    • cautions against unboosted atazanavir+ddI+FTC/3TC or nevirapine+tenofovir+FTC/3TC, because of efficacy.
  • A new section on regimen simplification for virologically suppressed treatment-experienced patients.
  • The guidelines include an option for 6-monthly CD4 and viral load monitoring once patients who are stable and suppressed on treatment for 2-3 years.
  • Many tables are updated to include newer drugs and tests.

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