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Practically Everything You Ever Wanted to Know About the Meds

By Enid Vázquez

September/October 2011

Practically Everything You Ever Wanted to Know About the Meds

You may have seen a handy little graphic on what to use when starting HIV therapy. It appears in every issue of Positively Aware's Annual HIV Drug Guide, among other places. That graphic is taken from U.S. HIV treatment guidelines, but there is so much more to the guidelines than just that one table.

There are dozens of tables, in fact: advantages and disadvantages of every HIV drug; drug interactions between medications for HIV and those for opioid dependence; HIV drug combinations never to take; and so on and so forth. All basically handy-dandy little lists of good things to know.

Then there is the text, in mostly understandable language, though not fun to read. This 166-page manual can put you to sleep with just one paragraph. (To wit, its very title is "Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents." Simple, yes. Exciting? No.)

Some of the many topics covered include co-infection with hepatitis B and C; lab tests and how often to take them; HIV drug resistance; and adherence (how to take the medications correctly).

So you can think of the guidelines as a useful manual to race through, looking for what you need to know, when you need to know it. Just remember that the guidelines are just that -- a guide, not rules set in stone. And furthermore, that they are updated on a regular basis. Recommendations are rated according to the strength of the evidence behind them.

One of the best things about the guidelines is that they follow the ups and downs of treatment knowledge and controversy, although not necessarily instantaneously.

The guidelines are issued by the U.S. Department of Health and Human Services (DHHS), and produced by a panel of experts, including people living with HIV. The panel looks at the latest and most important data. For example, the consensus on when to start treatment has changed over the years from beginning at a low CD4+ T-cell count to starting at higher levels, and will continue to change. That question has not yet been absolutely answered!

In cases where the best scientific data has yet to be produced, the DHHS panel "attempted to reflect reasonable options in its conclusions." The manual also notes that, "Guidelines are only a starting point for medical decision-making. They can identify some of the boundaries of high-quality care but cannot substitute for sound judgment."

Another important use for the guidelines is to guide health care workers (the reason for its existence, actually), especially those providers with less experience in treating HIV. So, pointing out some information to your providers, as you see fit, might be helpful. It's also good to see what your providers might be thinking.

In addition to this most often referenced set of guidelines (for adults and adolescents), the DHHS also produces HIV treatment guidelines for opportunistic infections, pediatrics, pregnant women, and post-exposure prevention (both health care-related and non-medical). Moreover, the International AIDS Society-USA also produces a set of HIV treatment guidelines, as well as HIV drug resistance testing guidelines; go to Go to to view all the government guidelines. Note: DHHS no longer mails out copies.

Highlights From the Guidelines

The following are taken directly from the guidelines for HIV treatment from the U.S. Department of Health and Human Services, with minor editing:

Initial evaluation should include:

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