Guidelines hiv 2008

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Guidelines for the Use of Antiretroviral
Agents in HIV-1-Infected
Adults and Adolescents
January 29, 2008

Developed by the DHHS Panel on
Antiretroviral Guidelines for Adults
and Adolescents – A Working Group of the
Office of AIDS Research Advisory Council (OARAC)

How to Cite the Adult and Adolescent Guidelines:
Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelinesfor the use of antiretroviral agents in HIV-1-infected adults and adolescents.
Department of Health and Human Services. January 29, 2008; 1-128. Available
at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
Accessed (insert date) [insert page number, table number, etc. if applicable]
It is emphasized that concepts relevant to HIV management evolve
rapidly. The Panel has amechanism to update recommendations on a
regular basis, and the most recent information is available on the
AIDSinfo Web site (http://AIDSinfo.nih.gov).

January 29, 2008

What’s New in the Document?
The following changes have been made to several sections of the December 1, 2007 version of the guidelines.

What to Start: Initial Combination Regimens for the Antiretroviral-Naïve Patient?The Panel revised its recommendations for several “preferred” and “alternative” antiretroviral components for
treatment-naïve patients:
“Abacavir + lamivudine” has been changed from “alternative” to “preferred” 2-NRTI component in patients
who have tested negative for HLA-B*5701 (AII).
“Zidovudine + lamivudine” has been changed from “preferred” to “alternative” 2-NRTI component (BII).“Ritonavir-boosted saquinavir” has been changed from a PI-option that was considered as “Acceptable as
initial antiretroviral components but inferior to preferred or alternative components” to an “alternative” PI
component (BII).
The following options are no longer recommended as components for initial therapy in treatment-naïve
patients:
o Nelfinavir as PI component
o Stavudine + lamivudine as2-NRTI components
o Abacavir + zidovudine + lamivudine as a triple-NRTI combination regimen
A new topic entitled “Other Treatment Options Under Investigation: Insufficient Data to Recommend” has been
added, which includes a review of recent clinical trial data in treatment-naïve patients for ritonavir-boosted darunavirbased regimens, maraviroc-based regimens, and raltegravir-based regimens.Treatment Interruption
This section has been updated with recent data on short-term and long-term treatment interruption. The Panel
reaffirms our recommendation that aside from unplanned or planned short-term interruption due to illnesses
precluding oral therapy or toxicities, long-term treatment interruption is not recommended unless in the context of a
clinical trial (DI).
Acute HIV Infection
•A new table on “Identifying, diagnosing, and managing acute HIV-1 infection” has replaced the table on
“Associated signs and symptoms of acute retroviral syndrome and percentage of expected frequency”.
• The Panel also recommends that since clinically significant resistance to PIs is less common than resistance to
NNRTIs in antiretroviral-naïve persons who harbor drug resistant virus, iftherapy is initiated before drug resistance
test results are available, consideration should be given to using a PI-based regimen (BIII).
Mycobacterium Tuberculosis Disease or Latent Tuberculosis Infection with HIV Coinfection
This section has been updated with the following information:
• Discussions and recommendations on the timing of initiation of antiretroviral therapy in patients with activetuberculosis (TB), with emphasis on the risks and benefits of concomitant therapy related to overlapping toxicities,
drug interactions, CD4 cell counts, and potential for immune reconstitution inflammatory syndrome.
• Recommendation for repeat testing to detect latent TB infection in persons who had CD4 count 200 cells/mm3 (BII).
Table Updates:
• Various tables have been updated to...
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