New Guidelines Help Sort Out HIV Drug Maze

On Sunday at the 16th International AIDS Conference in Toronto, researchers presented reports that revise HIV treatment guidelines to keep them simple, current, and flexible. Issued by the nonprofit International AIDS Society-USA Panel, the updated adult HIV treatment recommendations are also published in the Journal of the American Medical Association.

"We now have 22 antiretroviral agents in five classes that are [Food and Drug Administration] approved," said co-author Dr. Scott Hammer of Columbia University. "Despite the optimism, we are still faced with lots of drug toxicity issues," he said. Patients taking one drug may find their HIV has developed cross-resistance to other, similar drugs.

The IAS treatment guidelines elucidate when antiretroviral (ARV) therapy should begin, at what level of immune function ARV should start, and when to change the regimen. The recommendations sort through various cocktail choices conforming to World Health Organization standards.

The IAS panel recommends patients begin with a three drug cocktail containing either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor boosted with low-dose ritonavir, together with two nucleoside or nucleotide reverse transcriptase inhibitors. As PIs are expensive, WHO recommends waiting until they are necessary.

Some of the ARV drug recommendations are for patients whose virus has evolved drug resistance. Many of these agents are newer drugs. However, there is clear evidence older, mainstay drugs can keep the virus suppressed, keeping the immune system and the patient healthy.

The full report, "Treatment for Adult HIV Infection: 2006 Recommendations of the International AIDS Society-USA Panel," was published in Journal of the American Medical Association (2006;296(7):827-843).

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