Key Points
ÎAntiretroviral therapy (ART) is recommended for all HIV-infected individuals. The strength of this recommendation varies based on pretreatment CD4 count (see Table 1).*
ÎART is strongly recommended, regardless of CD4 count, in patients with certain conditions and should be offered to patients at risk of transmitting HIV to sexual partners (See Table 1).
ÎThe Panel recommends the following as preferred regimens for antiretroviral (ARV)-naïve patients:
• EFV/TDF/FTC (AI) • ATV/r + TDF/FTC (AI) • DRV/r + TDF/FTC (AI) • RAL + TDF/FTC (AI)
ÎOther regimens ("Alternative," "Acceptable," "Regimens that may be acceptable but more data are needed," "Regimens that may be acceptable but should be used with caution," and "Regimens and components that should not be offered") are shown in Tables 3 and 4.
ÎVirologic failure is newly defined as the inability to achieve or maintain suppression of viral replication (to an HIV RNA level < 200 copies/mL).
ÎGenotypic testing is recommended as the preferred resistance testing to guide therapy in patients with suboptimal virologic responses or virologic failure while on first or second regimens (AIII). Addition of phenotypic testing to genotypic testing is generally preferred for persons with known or suspected complex drug resistance mutation patterns, particularly to protease inhibitors (BIII).
Treatment Goals
ÎReduce HIV-associated morbidity and prolong the duration and quality of survival,
ÎRestore and preserve immunologic function, ÎMaximally and durably suppress viral load, and ÎPrevent HIV transmission.
* Evidence from randomized clinical trials supporting a benefit of ART is not available. However, support for earlier therapy is based on: (1) A report from at least one recent cohort study demonstrating survival benefit with initiation of ART at CD4 count > 500 cells/mm3
(2) Growing awareness that untreated HIV infection may be associated with development of many non-AIDS-defining diseases, including cardiovascular disease, kidney disease, liver disease, and malignancy;
;
(3) Greater efficacy, convenience, tolerability and safety of current antiretroviral regimens; and (4) Increasing evidence that effective ART reduces HIV transmission (BIII).
