US treatment guidelines updated (Jan 2005)
Updated guidelines on HIV treatment for adults and adolescents have been released by the U.S. Department of Health and Human Services (DHHS).
Among the most important changes:
- Stavudine (d4T, Zerit) has been changed from a “preferred” to an “alternative” medication due to toxicity concerns, particularly facial wasting and neuropathy;
- The recently approved NRTI emtricitabine (FTC, Emtriva) has been added as an option to both the “preferred” and “alternative” lists of first-line regimens when used as part of a dual-NRTI backbone;
- The dual-NRTI backbone of tenofovir (Viread) plus lamivudine (3TC, Epivir) or emtricitabine is now recommended for protease inhibitor-based regimens as well as NNRTI-based regimens; and
- For asymptomatic, treatment-naive patients with CD4+ cell counts above 350, the viral load recommendation to defer or to consider therapy has been increased from 55,000 to 100,000 copies/mL.
The new guidelines also feature discussions on HIV treatment in specific subpopulations of patients, including adolescents, injection drug users and patients coinfected with hepatitis or tuberculosis.
Powerpoint Summaries of Updated DHHS Guidelines
Four sets of PowerPoint slide presentations, including author comments, are available from the AIDS Education and Training Centers (AETC) National Resource Center.
Each slide presentation provides a review of the most important indications and recommendations together with speakers notes.
- Comprehensive Guideline Summary (44 slides)
- Initiation of Therapy (56 slides)
- Changing Therapy (30 slides)
- Special Issues (52 slides) includes acute HIV infection, treatment for adolescents, treatment for pregnant women, injection drug users, patients with HBV and HCV coinfection, TB, prevention counseling.