Guidelines for the use of antiretroviral agents in HIV-1-Infected Adults and Adolescents
Newly updated US antiretroviral treatment guidelines are recommending antiretroviral treatment for all people with HIV infection
Newly updated US antiretroviral treatment guidelines are recommending antiretroviral treatment for all people with HIV infection. With emphasis based on several population groups which include HIV positive people with CD4 cell counts below 500, those at risk of transmitting HIV to partners, pregnant women and anyone with hepatitis B co-infection or HIV-related kidney disease. The new US guidelines draw attention to data from two large cohort studies, which show that any degree of uncontrolled viral replication above 500 copies/ml, and the duration of uncontrolled viral replication, are each associated with a higher risk of death. The new recommendations strengthen previous US recommendations on when to start treatment, which recommended initiating treatment at CD4 cell counts between 350 and 500 cells/mm3. The guidelines also note an association between HIV infection, immunosuppression and an increased risk of cardiovascular disease, and malignancies. As well as highlighting that older patients consistently have poorer CD4 cell responses after starting treatment, thus suggesting that starting treatment earlier may result in better CD4 cell responses to treatment. These guidelines are in contrast to the new British HIV Association guidelines which continue to recommend treatment when CD4 cell count falls below 350 cells.
