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New HIV Treatment Guidelines Focus on "Preferred" Regimens
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents PDF format
The latest HIV treatment guidelines released on Monday by the US Department of Health and Human Services (DHHS) classify combination regimens as either "preferred" or "alternative"--a change that could simplify therapeutic decisions for clinicians.
The Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents have been revised eight times since first being published in 1998. They are produced by a DHHS panel that meets every few months to discuss if changes are warranted.
Previous versions of the guidelines have required clinicians to build a regimen by selecting antiretroviral drugs from different columns of acceptable agents. Although this method was useful at the time, the number of agents has grown so much in recent years that such an approach has become too complicated.
The new guidelines consist of already constructed regimens that, on the basis of trial results and expert opinion, are classified as either preferred or alternative.
"The goal with the new guidelines was really to make it easier for clinicians to select treatment," Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, told Reuters Health. "We now have 22 different antiretroviral formulations and 19 separate drugs, which makes selecting therapy very difficult."
"Probably the most important new aspect of the revised guidelines is that we clearly delineate what the preferred choice is for an NNRTI-based regimen and for a PI-based regimen," Dr. Fauci noted. "There is no more picking one from column A, one from column B, and so on."
But the grouping of regimens according to preference is not the only new aspect of the revised guidelines. For the first time, "the guidelines give the pros and cons of each of the individual components of the regimens," Dr. Fauci said. "This has not been clearly delineated before" and it should help clinicians tailor the regimen to a specific patient, he added.
Another difference from previous guidelines is a greater emphasis on how to manage treatment failures. For example, the guidelines now address when it is important to do resistance testing. "Before we were somewhat noncommittal about that," he said.
Dr. Fauci noted that fusion inhibitors are described in the guidelines, but they are not yet listed in the table of recommended drugs. "They're mentioned as a new class of drugs to keep an eye out for and what the potential reasons for using them are." Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents PDF format

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