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What's New in the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents

January 10, 2011

Key changes made to update the December 1, 2009, version of the guidelines are summarized below. Throughout the revised guidelines, significant updates are highlighted and fully discussed.


The Panel emphasizes its recognition of the importance of clinical research in generating evidence to address unanswered questions related to the optimal safety and efficacy of antiretroviral therapy (ART). The Panel encourages both the development of protocols and patient participation in well-designed, Institutional Review Board (IRB)-approved clinical trials.

CD4 T-Cell Count

The Panel recognizes that changes in CD4 cell count are seldom used in decision for ART changes in a patient on a suppressive ART regimen whose CD4 count is well above the threshold for opportunistic infection risk. In such patients, the Panel recommends that the CD4 count may be monitored less frequently, for example every 6 to 12 months (instead of every 3 to 6 months), unless there are changes in the patient's clinical status, such as new HIV-associated clinical symptoms or initiation of treatment with interferon, corticosteroids, or anti-neoplastic agents (CIII).

Viral Load Testing

The Panel recognizes that low-level positive viral load results (typically <200 copies/mL) have been commonly reported with some viral load assays. For the purpose of patient monitoring, the Panel defines virologic failure as a confirmed viral load >200 copies/mL, which eliminates most cases of viremia caused by isolated blips or assay variability.

Drug-Resistance Testing

The Panel provides more specific recommendations on when to use genotypic testing to detect resistance to integrase strand transfer inhibitors (INSTIs).

What to Start: Initial Combination Regimens for the Antiretroviral-Naive Patient

Changes to the "What to Start" recommendations include the following:

Hepatitis B (HBV)/HIV Coinfection

This section has been revised to provide more specific recommendations for management of HIV patients coinfected with HBV, including recommendations for patients with 3TC/FTC-resistant HBV infection and for patients who cannot tolerate TDF-based regimens.

Mycobacterium Tuberculosis Disease With HIV Coinfection

Based on recent randomized controlled trials showing survival and clinical benefits of starting ART earlier in treatment-naive patients with active tuberculosis (TB) disease, the Panel provides the following recommendations on when to start ART in patients who are receiving treatment for active TB but are not yet on ART.

Adverse Effects of Antiretroviral Agents

A new table format provides clinicians with a list of the most common and/or severe known antiretroviral (ARV)-associated adverse events listed by ARV drug class.

Additional Updates

The following sections and their relevant tables have also been updated:

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