HIV and AIDS Treatment Guidelines

the Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents released their latest guidelines for HIV and AIDS treatment. Every year, the panel assesses the current trends in HIV and AIDS treatment and new information gained from research and develops a set of guidelines for the use of HIV medications and AIDS treatment. The last set of these guidelines were made public in October 2006. Some changes were made and this article takes a look at those changes and how they differ from the last set of guidelines from 2006.

Laboratory Assessment

There are some new recommendations as to how blood tests should be used to guide HIV treatment choices.

  • Drug Resistance Testing – The Panel recommends performing genotypic drug resistance testing for all treatment-naive (never been on HIV medications) patients entering into HIV care, regardless of whether antiretroviral therapy is to be started. This recommendation is based on the fact that people can become infected by resistant virus, meaning the newly infected person will have resistance despite never being on medications. Repeat testing may be considered later when HIV therapy is to be started.

    A Step-By-Step Guide To HIV Resistance

    What is Resistance Testing

  • Tropism Assay – The Panel recommends tropism testing prior to the start of a CCR5 inhibitor, such as maraviroc.

    What Are CCR5 Inhibitors

    Maraviroc Fact Sheet

    What is Tropism & Tropism Assay

  • HLA-B Testing – The Panel recommends HLA-B testing prior to initiating abacavir therapy to reduce the risk of hypersensitivity reaction. Patients with the HLA-B genetic variant have been identified in studies as at risk for hypersensitivity reactions to Ziagen (abacavir). Those who test positive for HLA-B should not be prescribed Ziagen (abacavir) and the positive status should be recorded as an abacavir allergy in the patient’s medical record. When HLA-B screening is not readily available, it remains reasonable to initiate Ziagen (abacavir) with appropriate clinical counseling and monitoring for any signs of abacavir-associated hypersensitivity reaction.

    What is a Ziagen Hypersensitivity Reaction?

    Ziagen (abacavir) Fact Sheet

When To Start Therapy

There are new recommendations as to when HIV medications should be started. These changes include the following.

  • The Panel recommends that antiretroviral therapy should be initiated in patients with history of an AIDS-defining illness or with a CD4 T-cell count <350 cells/mm3. The data supporting this recommendation is stronger for those with a CD4 T-cell count <200 cells/mm3 and with a history of AIDS than for those with CD4 T-cell counts between 200 and 350 cells/mm3.

    What is CD4 Count

    What Are The AIDS Defining Illnesses

  • The Panel also recommends treatment for the following groups regardless of CD4 T-cell count:
    • pregnant patients
    • patients with HIV associated kidney disease
    • patients coinfected with hepatitis B when treatment for hepatitis B virus is indicated.

    HIV and Pregnancy

    Women and HIV

    Hepatitis B Fact Sheets

  • The optimal time to initiate therapy in asymptomatic patients with CD4 T-cell count >350 cells/mm3 is not well defined. The decision of whether or not to start therapy in these patients should take into account the potential benefits and risks associated with therapy, other illnesses, and patient readiness and willingness to adhere to long-term treatment.