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US HHS Adult Treatment Guidelines Updated; Comparison With UK BHIVA Guidelines

March/April 2012

Updated US guidelines from the DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents are available online.

Key additions and revisions to the guidelines include:


  1. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents (March 2012) campaign=Adult%2BGuidelines%2B1



It is always particularly helpful that these guidelines clearly highlight all changes in the text from the previous edition. There are several notable differences compared to the UK BHIVA guidelines (March 2012 draft).

This includes the new US section on HIV and ageing, with age >50 years being an independent factor for starting treatment. Although UK guidelines included this recommendation in 2008 it has been dropped from the 2012 draft.

Also, for starting treatment at higher CD4 counts (at 500 compared to 350) with the US also having a stronger indication for starting at higher than 500, with no CD4 exclusion criteria. This last difference is not based on new evidence about the short-term risk of disease progression, AIDS events or mortality from randomised studies -- this will come from the ongoing START study -- but from accumulating concerns about uncontrolled viraemia and it's impact on immune inflammation, and also on the benefit of ARV treatment to reduce further transmission.

The latest BHIVA guideline were released in draft format last month for comment and are still online while the final version is in press.

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