US adult treatment guidelines updated (Oct 2006)
On October 10, 2006, the DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents released a new revision of the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents.
Most of the changes to the previous edition (highlighted in yellow in the pdf file) relate to recommendations for preferred and alternative antiretroviral components in treatment-naive patients and on safety data that have emerged since the last revision.
Two boosted PI-regimens have been added to recommended first-line regimens: atazanavir/ritonavir (once daily) and fosamprenavir/ritonavir (twice-daily), both plus 2 RTIs. Previous recommendations only included efavirenz plus 2 RTIs or lopinaivr/ritonavir plus 2 RTIs.
The recommendations for choice of nucleosides are fixed dose combinations of either tenofovir/FTC or AZT/3TC. Alternative options are abacavir/3TC or ddI with either 3TC or FTC.
Tables 28 and 29 have been revised according to updates in the Perinatal Guidelines to incorporate preclinical and clinical data relevant to the use of darunavir during pregnancy and new recommendations on antiretroviral use during pregnancy.
Table 30 has been updated to include information on expanded access programs for two investigational agents, TMC125 and MK-0518.
The complete October 10, 2006, version of the adult treatment guidelines is available on the AIDSinfo web site at:
It is noticeable that AZT remains a first-line preferred nucleoside and that no reference is made to the evidence linking AZT to lipoatrophy, which led to UK guidelines in July 2005 downgrading the use of AZT to that of an alternative option.
Source: FDA listserv