December 1, 2009
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EXPERT PANEL REVISES U.S. HIV TREATMENT GUIDELINES


 The Highlights: Updated Recommendations for Starting HIV Treatment

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.

Here are a few of the major changes in these revised guidelines, which were put together by a panel of 30 HIV/AIDS experts from across the U.S. You can also read and discuss the changes anytime using our guidelines summary page at TheBody.com!

  • Earlier Treatment Recommended: 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).

  • Immediate Treatment Urged for Some: The guidelines note that some people should start HIV treatment no matter what their CD4 count is: Pregnant women, people with HIV-related kidney disease and people who have both HIV and hepatitis B and need to be treated for their hep B infection. (These exceptions were in the last version of the guidelines, too.)

  • Is There Such a Thing as Starting Meds "Too Early"? 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 With: There are now four specific regimens that are considered "preferred" for first-line treatment:
    • Atripla
    • Isentress and Truvada
    • Norvir, Prezista and Truvada
    • Norvir, Reyataz and Truvada
    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 Demoted: Kaletra has been removed from the list of "preferred" first-line HIV meds; it's now generally considered an "alternative" medication, mainly because it carries a heightened risk for gastrointestinal side effects and high lipid levels. That said, the twice-daily dose of Kaletra is still a recommended medication for HIV-positive pregnant women.
Over the next few days, we'll provide more information and analysis on what these revised guidelines mean for people living with HIV, whether you have yet to start treatment or are already on HIV meds.

Stay tuned for our upcoming one-on-one interview with David Wohl, M.D., one of the physicians on the expert panel that revises the guidelines!

In the meantime, you can comment on these changes on our guidelines summary page at TheBody.com; browse a full, official listing of the revisions; or download the guidelines in their entirety (as a 168-page PDF file).


 Meanwhile, in Other Guidelines: WHO Recommends Earlier HIV Treatment in Resource-Poor Countries

On Nov. 30, the World Health Organization (WHO) revised its own HIV treatment guidelines, which are meant primarily for developing countries. The updated WHO guidelines increase the recommended CD4 count for starting treatment to 350 (it had been 200), which may make as many as five million more HIVers eligible for HIV meds throughout the world, WHO says. For more on this story, read our summary at TheBody.com.


 In Europe, a Focus on Aging-Related Illnesses Among People With HIV

The European AIDS Clinical Society updated its own set of HIV treatment guidelines just a few weeks ago. They differ from the new U.S. guidelines on a few points (read our online summary to learn more). They also include a host of prevention, testing and treatment recommendations for cancer, heart problems, bone disorders and other health issues traditionally associated with aging that are growing more common among HIVers as they get older.




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