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IAS-USA recommends treatment for all patients with HIV, regardless of CD4 count

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The 2012 recommendations of the International Antiviral Society–USA suggest that all adults with HIV be offered antiretroviral therapy regardless of CD4 cell count.

The strength of the recommendation and the quality of the evidence supporting initiation of therapy increase as the CD4 cell count decreases and when certain concurrent conditions are present, the researchers from the International Antiviral Society–USA wrote in the Journal of the American Medical Association.

Pregnant women and those receiving treatment for tuberculosis are also recommended to start treatment if infected with HIV, as are those with hepatitis B virus and patients aged older than 60 years. Patients with hepatitis C virus may need to delay ART until completion of treatment for HCV.

Other recommendations include what regimens treatment plans should include. The initial regimens should include two nucleoside reverse transcriptase inhibitors — either tenofovir/emtricitabine (Truvada, Gilead Sciences) or abacavir/lamivudine (Epzicom, Viiv Healthcare) — plus a nonnucleoside reverse transcriptase inhibitor, a ritonavir-boosted protease inhibitor or an integrase strand transfer inhibitor. Special considerations for treatment plans must be taken for pregnant women, patients with comorbid diseases and those with opportunistic infections, cirrhosis, hepatitis B, hepatitis C or malignancy.

The recommendations also suggest that plasma HIV RNA levels and CD4 count be monitored ever 3 months after treatment is initiated. When viral load is suppressed for 1 year and CD4 count is stable, then they can be monitored every 6 months. In addition, detectable HIV RNA should be confirmed 2 to 4 weeks after in a subsequent sample before making treatment changes. Sustained elevation of HIV RNA should prompt consideration for treatment changes.

References:

Thompson MA. JAMA. 2012;308:387-402.

Disclosures:

The authors report financial relationships with Boehringer-Ingelheim, Bristol-Myers Squibb, Cepheid, GeoVax, Gilead, GlaxoSmithKline, Inhibitex, Janssen-Cilag, Kaketsuken, Kowa Research Institute, Merck Research Laboratories, Myriad, Peregrine, Pfizer, Progenics, Roche Molecular Systems, 3-V Biologicas, Theratechnologies, Tibotec, Tobira, Viiv Healthcare, Sharp & Dohme, Roche, Johnson & Johnson Services, Laboratory Corp of America, Santaris Pharma, Achillion, Avexa, Pharmasset, TaiMed Biologics, Argos, Chimerix, Virco Laboratories, MedImmune, Grupo Ferrer, Biota, Gen-Probe and Monogram Biosciences.