Huldrych F Günthard1, Judith A Aberg2, Joseph J Eron3, Jennifer F Hoy4, Amalio Telenti5, Constance A Benson6, David M Burger7, Pedro Cahn8, Joel E Gallant9, Marshall J Glesby10, Peter Reiss11, Michael S Saag12, David L Thomas13, Donna M Jacobsen14, Paul A Volberding15. 1. University Hospital Zurich, Zurich, Switzerland. 2. Icahn School of Medicine at Mount Sinai, New York, New York. 3. University of North Carolina School of Medicine, Chapel Hill. 4. Alfred Hospital and Monash University, Melbourne, Australia. 5. University Hospital of Lausanne, Lausanne, Switzerland. 6. University of California School of Medicine, San Diego. 7. Radboud University Medical Center, Nijmegen, the Netherlands. 8. Hospital Juan Fernandez/University of Buenos Aires Medical School and Fundacion Huesped, Buenos Aires, Argentina. 9. Southwest CARE Center, Santa Fe, New Mexico. 10. Weill Cornell Medical College, New York, New York. 11. Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 12. University of Alabama at Birmingham. 13. Johns Hopkins University School of Medicine, Baltimore, Maryland. 14. International Antiviral Society-USA, San Francisco, California. 15. University of California, San Francisco.
Abstract
IMPORTANCE: New data and antiretroviral regimens expand treatment choices in resource-rich settings and warrant an update of recommendations to treat adults infected with human immunodeficiency virus (HIV). OBJECTIVE: To provide updated treatment recommendations for adults with HIV, emphasizing when to start treatment; what treatment to start; the use of laboratory monitoring tools; and managing treatment failure, switches, and simplification. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS: An International Antiviral Society-USA panel of experts in HIV research and patient care considered previous data and reviewed new data since the 2012 update with literature searches in PubMed and EMBASE through June 2014. Recommendations and ratings were based on the quality of evidence and consensus. RESULTS: Antiretroviral therapy is recommended for all adults with HIV infection. Evidence for benefits of treatment and quality of available data increase at lower CD4 cell counts. Recommended initial regimens include 2 nucleoside reverse transcriptase inhibitors (NRTIs; abacavir/lamivudine or tenofovir disoproxil fumarate/emtricitabine) and a third single or boosted drug, which should be an integrase strand transfer inhibitor (dolutegravir, elvitegravir, or raltegravir), a nonnucleoside reverse transcriptase inhibitor (efavirenz or rilpivirine) or a boosted protease inhibitor (darunavir or atazanavir). Alternative regimens are available. Boosted protease inhibitor monotherapy is generally not recommended, but NRTI-sparing approaches may be considered. New guidance for optimal timing of monitoring of laboratory parameters is provided. Suspected treatment failure warrants rapid confirmation, performance of resistance testing while the patient is receiving the failing regimen, and evaluation of reasons for failure before consideration of switching therapy. Regimen switches for adverse effects, convenience, or to reduce costs should not jeopardize antiretroviral potency. CONCLUSIONS AND RELEVANCE: After confirmed diagnosis of HIV infection, antiretroviral therapy should be initiated in all individuals who are willing and ready to start treatment. Regimens should be selected or changed based on resistance test results with consideration of dosing frequency, pill burden, adverse toxic effect profiles, comorbidities, and drug interactions.
IMPORTANCE: New data and antiretroviral regimens expand treatment choices in resource-rich settings and warrant an update of recommendations to treat adults infected with human immunodeficiency virus (HIV). OBJECTIVE: To provide updated treatment recommendations for adults with HIV, emphasizing when to start treatment; what treatment to start; the use of laboratory monitoring tools; and managing treatment failure, switches, and simplification. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS: An International Antiviral Society-USA panel of experts in HIV research and patient care considered previous data and reviewed new data since the 2012 update with literature searches in PubMed and EMBASE through June 2014. Recommendations and ratings were based on the quality of evidence and consensus. RESULTS: Antiretroviral therapy is recommended for all adults with HIV infection. Evidence for benefits of treatment and quality of available data increase at lower CD4 cell counts. Recommended initial regimens include 2 nucleoside reverse transcriptase inhibitors (NRTIs; abacavir/lamivudine or tenofovir disoproxil fumarate/emtricitabine) and a third single or boosted drug, which should be an integrase strand transfer inhibitor (dolutegravir, elvitegravir, or raltegravir), a nonnucleoside reverse transcriptase inhibitor (efavirenz or rilpivirine) or a boosted protease inhibitor (darunavir or atazanavir). Alternative regimens are available. Boosted protease inhibitor monotherapy is generally not recommended, but NRTI-sparing approaches may be considered. New guidance for optimal timing of monitoring of laboratory parameters is provided. Suspected treatment failure warrants rapid confirmation, performance of resistance testing while the patient is receiving the failing regimen, and evaluation of reasons for failure before consideration of switching therapy. Regimen switches for adverse effects, convenience, or to reduce costs should not jeopardize antiretroviral potency. CONCLUSIONS AND RELEVANCE: After confirmed diagnosis of HIV infection, antiretroviral therapy should be initiated in all individuals who are willing and ready to start treatment. Regimens should be selected or changed based on resistance test results with consideration of dosing frequency, pill burden, adverse toxic effect profiles, comorbidities, and drug interactions.
Authors: Sara Lodi; Andrew Phillips; Roger Logan; Ashley Olson; Dominique Costagliola; Sophie Abgrall; Ard van Sighem; Peter Reiss; José M Miró; Elena Ferrer; Amy Justice; Neel Gandhi; Heiner C Bucher; Hansjakob Furrer; Santiago Moreno; Susana Monge; Giota Touloumi; Nikos Pantazis; Jonathan Sterne; Jessica G Young; Laurence Meyer; Rémonie Seng; Francois Dabis; Marie-Anne Vandehende; Santiago Pérez-Hoyos; Inma Jarrín; Sophie Jose; Caroline Sabin; Miguel A Hernán Journal: Lancet HIV Date: 2015-07-07 Impact factor: 12.767
Authors: Annemarie M Wensing; Vincent Calvez; Huldrych F Günthard; Victoria A Johnson; Roger Paredes; Deenan Pillay; Robert W Shafer; Douglas D Richman Journal: Top Antivir Med Date: 2015 Oct-Nov
Authors: Gary Marks; Lytt I Gardner; Charles E Rose; Anne Zinski; Richard D Moore; Susan Holman; Allan E Rodriguez; Meg Sullivan; Thomas P Giordano Journal: AIDS Date: 2015-05-15 Impact factor: 4.177