July 27, 2010
"Successful antiretroviral therapy (ART) is associated with dramatic decreases in AIDS-defining conditions and their associated mortality," the authors wrote in introducing their updated treatment recommendations.
Since the 2008 guidelines were published, new data have emerged regarding the consequences of untreated HIV infection and the expansion of treatment options for ART-naive and -experienced patients, observed the panel.
"Uncontrolled HIV replication and immune activation lead to a chronic inflammatory state, resulting in end-organ damage and comorbid conditions not previously thought to be associated with HIV infection," the authors wrote. "Several studies have shown that the lifespan of those with HIV infection still falls short of that of the general population, even at higher CD4 cell counts. This life span decrease is related to serious, non-AIDS events attributed to chronic immune activation and the potentially permanent immune damage associated with prolonged immune depletion."
"Patient readiness for treatment should be confirmed before initiation of antiretroviral treatment," the panel said. "Therapy is recommended for asymptomatic patients with a CD4 cell count less than or equal to 500/microliter, for all symptomatic patients, and those with specific conditions and comorbidities. Therapy should be considered for asymptomatic patients with CD4 cell count above 500/microliter.
"Components of the initial and subsequent regimens must be individualized, particularly in the context of concurrent conditions," wrote the authors, who presented these considerations in an accompanying table. "Patients receiving antiretroviral treatment should be monitored regularly; treatment failure should be detected and managed early, with the goal of therapy, even in heavily pretreated patients, being HIV-1 RNA suppression below commercially available assay quantification limits," the panel advised.
The full recommendations are available online via open access; visit http://jama.ama-assn.org/cgi/content/full/304/3/321.