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What's New in the U.S. DHHS Antiretroviral Therapy Guidelines for Adults and Adolescents

February 12, 2013

The following appears at the beginning of the February 12, 2013, revision to the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents.

The following key changes were made to update the March 28, 2012, version of the guidelines.

Drug-Resistance Testing
In persons failing INSTI-based regimens, the panel now recommends that a genotypic assay for INSTI resistance should be performed to determine whether to include a drug from this class in subsequent regimens (AII). Previously, the Panel recommended that INSTI resistance testing should be considered (BIII) in this setting.

Co-Receptor Tropism Assay
A genotypic tropism assay is now commercially available. The assay predicts HIV-1 co-receptor usage based on sequencing of the V3-coding region of HIV-1 env, the principal determinant of co-receptor usage. The Panel recommends that a genotypic tropism assay be used as an alternative to a phenotypic tropism assay before initiation of a CCR5 antagonist-containing regimen (BII).

Initiating ART in Treatment-Naive Patients
The Panel has updated its recommendations on initiation of ART in treatment-naive patients. The Panel's recommendations are listed below.

What to Start: Initial Combination Regimen for Antiretroviral-Naive Patients
The following changes and updates were made to this section:

Acute and Recent (Early) HIV Infection

HIV-Infected Women

Drug-Drug Interaction

Additional Updates
Minor revisions have also been made to the following sections:

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