Expert Panel Revises U.S. HIV/AIDS Treatment Guidelines; Recommends Starting HIV Meds Earlier

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents (PDF)

On Dec. 1, the U.S. health department released an updated set of HIV treatment guidelines. Although these guidelines aren't official U.S. policy, they're regarded as the most reputable set of expert recommendations in the country, and many HIV health care workers are likely to follow them. The guidelines themselves were revised by a panel of 30 HIV/AIDS experts from across the U.S.

We'll summarize a few of the major changes in the revised guidelines below. A more detailed, official listing of changes is available online, as is a 168-page PDF of the full guidelines.

Check out our one-on-one interview with David Wohl, M.D., one of the physicians on the expert panel that revised the guidelines.

(HIV treatment guideline history buffs take note: This is the first time these guidelines have been updated since Nov. 3, 2008. They go by the formal title "Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents," although they're often referred to casually as the "D.H.H.S. guidelines," since the expert panel that revises them is convened by the U.S. Department of Health and Human Services.)

When to Start HIV/AIDS Treatment

For people who have never been on HIV meds before, starting treatment is now recommended at a CD4 count of 500 or less (up from 350 or less). However, the guidelines note (as they also did in the previous version of the guidelines) that there are some people who should start HIV treatment no matter what their CD4 count is:

• pregnant women
• people with HIV-related kidney disease
• people who have both HIV and hepatitis B, and who need to be treated for their hep B infection

The expert panel was split over whether people should begin HIV treatment at a CD4 count above 500. Half felt it was a good idea; the other half felt it was OK to consider it, but that a person should carefully weigh the pluses and minuses with their doctor first. (We'll go into detail about the potential good and bad points in an expert interview later this week.)

What to Start HIV Treatment With

There are now four specific regimens that are considered "preferred" for first-line treatment:

• Atripla (generic name: efavirenz/tenofovir/FTC)
• Isentress and Truvada (generic names: raltegravir and tenofovir/FTC)
• Norvir, Prezista and Truvada (generic names: ritonavir, darunavir and tenofovir/FTC)
• Norvir, Reyataz and Truvada (generic names: ritonavir, atazanavir and tenofovir/FTC)

Non-preferred first-line regimens are now split into various lists ("alternative," "acceptable," etc.) that include brief explanations for why it may or may not be wise to try them.

Kaletra (lopinavir/ritonavir) has been removed from the list of "preferred" first-line HIV meds; it's now generally considered an "alternative" medication, mainly because of gastrointestinal side effects, high lipid levels and drug interactions. That said, the twice-daily dose of Kaletra is still a recommended medication for HIV-positive pregnant women.

Upcoming Analysis and Your Comments

Check out our one-on-one interview with David Wohl, M.D., one of the physicians on the expert panel that revised the guidelines. We talked with him about what all of these guidelines developments truly mean for people living with HIV -- not only for those who have yet to start HIV treatment, but also for those who are already taking HIV meds.

In the meantime, feel free to let us know what you think in the comment area below! In addition, if you feel revisions need to be made to these updated U.S. guidelines, the guidelines note that the public has a two-week window to do so. The guidelines also state that people can write to the expert panel that revised the guidelines at any time by e-mailing contactus@aidsinfo.nih.gov.