HIV Treatment Guidelines
February 13, 2017
Table of Contents
Treatment guidelines provide a lot of useful information to help health care providers and people living with HIV make decisions about when to start, when to stop, and when to change HIV medications. They also help providers and people living with HIV (HIV+) choose among the many available HIV drugs.
A branch of the U.S. government, called the Department of Health and Human Services, (DHHS), has put together a set of HIV treatment guidelines. The U.S. DHHS provides several different treatment guidelines related to HIV care. These include the Perinatal Guidelines which provide treatment recommendations for pregnant women with HIV, the Treatment of Opportunistic Infections Guidelines which provide treatment recommendations for opportunistic infections, and the Pediatric Antiretroviral Treatment Guidelines. This fact sheet discusses only the recommendations contained within the Guidelines for Antiretroviral Treatment in Adults and Adolescents.
The DHHS guidelines are written and reviewed regularly by a group of HIV experts, including researchers, health care providers, and community activists. They were first published in 1998 and have been updated many times since then. The most recent guidelines were released in July 2016. The full version of the guidelines is available at http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf. Some of the important updates in the most recent version of the DHHS guidelines for the treatment of HIV in adults and adolescents are listed below.
In 2015, the World Health Organization (WHO) released new guidelines on when to start HIV treatment. By October 2015, all internationally-written guidelines were in agreement for the first time since 2006. The DHHS, WHO, EACS (European AIDS Clinical Society), BHIVA (British HIV Association), and the IAS-USA (International Antiviral Society-USA) now all recommend that HIV treatment be offered to all people living with HIV, regardless of their CD4 count. Researchers have shown that people living with HIV who start treatment earlier, while their CD4 counts are still high, have a much lower risk of illness and death.
The guidelines describe the goals of HIV treatment. They are basically to keep you as healthy and as well as possible using the best care and treatment available today. The goals are the same for people just starting treatment and those who have been on treatment for a long time. These include:
Some of the important updates in the most recent version of DHHS guidelines for the treatment of HIV in adults and adolescents are listed here:
More information on what the guidelines recommend is included below.
Over the years there has been a lot of discussion and debate about when to start treatment, especially for people living with HIV with high CD4 counts -- those who have no signs of ill health and are relatively healthy. The guidelines have been changed a number of times. Some earlier versions recommended that people wait longer before starting HIV treatment. This was because of concerns about the HIV drugs, such as side effects and difficult dosing schedules. It was thought that HIV was not as harmful as possible drug side effects in people with higher CD4 counts. We now understand this is not true.
The results of the START trial have definitively shown that people living with HIV who start treatment earlier, while their CD4 counts are still high, have a much lower risk of illness and death. This includes people living with HIV who may have no outward signs of ill health. The study showed that taking HIV drugs earlier reduced the likelihood of developing both AIDS-related and non-AIDS-related illnesses.
The START trial clearly showed that the benefits of starting treatment early outweigh any potential risks. Consequently, scientific experts and policy makers came together in July 2015 and issued a consensus statement declaring all people living with HIV should have access to HIV treatment as soon as they are diagnosed. This statement was supported by agencies such as the International AIDS Society, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and UNAIDS, among others.
Also, newer drug combinations now available are easier to take and have fewer side effects than older regimens. For all these reasons the newest guidelines recommend starting HIV treatment as soon as someone is diagnosed.
The current U.S. guidelines state:
Because starting treatment is such an important decision, the guidelines suggest that you and your provider discuss the benefits of treatment while also addressing any barriers. It is important to think about whether you are willing and able to take your HIV treatment as prescribed. In order to get the most benefit from HIV drugs, they must be used just the way they are prescribed. Taking your treatment correctly is as important as which drugs you and your health care provider choose. So before you get started, it is important to be prepared and commit to taking your HIV drugs the right way, every day for your own health. For more information, see our fact sheet on Considerations Before Starting HIV Treatment.
Benefits of Starting Early
There are benefits to starting HIV treatment early. These include:
Risks of Starting Late
There are also risks to starting HIV treatment late including:
This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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