Antiretroviral treatment of adult HIV infection: 2012 Recommendations of the International Antiviral Society-USA panel

Melanie A. Thompson, Judith A. Aberg, Jennifer F. Hoy, Amalio Telenti, Constance Benson, Pedro Cahn, Joseph J. Eron, Huldrych F. Günthard, Scott M. Hammer, Peter Reiss, Douglas D. Richman, Giuliano Rizzardini, David L Thomas, Donna M. Jacobsen, Paul A. Volberding

Research output: Contribution to journalArticle

Abstract

Context: New trial data and drug regimens that have become available in the last 2 years warrant an update to guidelines for antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-infected adults in resource-rich settings. Objective: To provide current recommendations for the treatment of adult HIV infection with ART and use of laboratory-monitoring tools. Guidelines include when to start therapy and with what drugs, monitoring for response and toxic effects, special considerations in therapy, and managing antiretroviral failure. Data Sources, Study Selection, and Data Extraction: Data that had been published or presented in abstract form at scientific conferences in the past 2 years were systematically searched and reviewed by an International Antiviral Society-USA panel. The panel reviewed available evidence and formed recommendations by full panel consensus. Data Synthesis: Treatment is recommended for all adults with HIV infection; the strength of the recommendation and the quality of the evidence increase with decreasing CD4 cell count and the presence of certain concurrent conditions. Recommended initial regimens include 2 nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine or abacavir/ lamivudine) plus a nonnucleoside reverse transcriptase inhibitor (efavirenz), a ritonavirboosted protease inhibitor (atazanavir or darunavir), or an integrase strand transfer inhibitor (raltegravir). Alternatives in each class are recommended for patients with or at risk of certain concurrent conditions. CD4 cell count and HIV-1 RNA level should be monitored, as should engagement in care, ART adherence, HIV drug resistance, and quality-of-care indicators. Reasons for regimen switching include virologic, immunologic, or clinical failure and drug toxicity or intolerance. Confirmed treatment failure should be addressed promptly and multiple factors considered. Conclusion: New recommendations for HIV patient care include offering ART to all patients regardless of CD4 cell count, changes in therapeutic options, and modifications in the timing and choice of ART in the setting of opportunistic illnesses such as cryptococcal disease and tuberculosis.

Original languageEnglish (US)
Pages (from-to)387-402
Number of pages16
JournalJournal of the American Medical Association
Volume308
Issue number4
DOIs
StatePublished - Jul 25 2012

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Virus Diseases
Antiviral Agents
HIV
CD4 Lymphocyte Count
Therapeutics
Reverse Transcriptase Inhibitors
Tenofovir
efavirenz
Guidelines
Integrases
Drug Monitoring
Quality of Health Care
Poisons
Information Storage and Retrieval
Protease Inhibitors
Drug-Related Side Effects and Adverse Reactions
Treatment Failure
Nucleosides
Drug Resistance
HIV-1

ASJC Scopus subject areas

  • Medicine(all)

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Antiretroviral treatment of adult HIV infection : 2012 Recommendations of the International Antiviral Society-USA panel. / Thompson, Melanie A.; Aberg, Judith A.; Hoy, Jennifer F.; Telenti, Amalio; Benson, Constance; Cahn, Pedro; Eron, Joseph J.; Günthard, Huldrych F.; Hammer, Scott M.; Reiss, Peter; Richman, Douglas D.; Rizzardini, Giuliano; Thomas, David L; Jacobsen, Donna M.; Volberding, Paul A.

In: Journal of the American Medical Association, Vol. 308, No. 4, 25.07.2012, p. 387-402.

Research output: Contribution to journalArticle

Thompson, MA, Aberg, JA, Hoy, JF, Telenti, A, Benson, C, Cahn, P, Eron, JJ, Günthard, HF, Hammer, SM, Reiss, P, Richman, DD, Rizzardini, G, Thomas, DL, Jacobsen, DM & Volberding, PA 2012, 'Antiretroviral treatment of adult HIV infection: 2012 Recommendations of the International Antiviral Society-USA panel', Journal of the American Medical Association, vol. 308, no. 4, pp. 387-402. https://doi.org/10.1001/jama.2012.7961
Thompson, Melanie A. ; Aberg, Judith A. ; Hoy, Jennifer F. ; Telenti, Amalio ; Benson, Constance ; Cahn, Pedro ; Eron, Joseph J. ; Günthard, Huldrych F. ; Hammer, Scott M. ; Reiss, Peter ; Richman, Douglas D. ; Rizzardini, Giuliano ; Thomas, David L ; Jacobsen, Donna M. ; Volberding, Paul A. / Antiretroviral treatment of adult HIV infection : 2012 Recommendations of the International Antiviral Society-USA panel. In: Journal of the American Medical Association. 2012 ; Vol. 308, No. 4. pp. 387-402.
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abstract = "Context: New trial data and drug regimens that have become available in the last 2 years warrant an update to guidelines for antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-infected adults in resource-rich settings. Objective: To provide current recommendations for the treatment of adult HIV infection with ART and use of laboratory-monitoring tools. Guidelines include when to start therapy and with what drugs, monitoring for response and toxic effects, special considerations in therapy, and managing antiretroviral failure. Data Sources, Study Selection, and Data Extraction: Data that had been published or presented in abstract form at scientific conferences in the past 2 years were systematically searched and reviewed by an International Antiviral Society-USA panel. The panel reviewed available evidence and formed recommendations by full panel consensus. Data Synthesis: Treatment is recommended for all adults with HIV infection; the strength of the recommendation and the quality of the evidence increase with decreasing CD4 cell count and the presence of certain concurrent conditions. Recommended initial regimens include 2 nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine or abacavir/ lamivudine) plus a nonnucleoside reverse transcriptase inhibitor (efavirenz), a ritonavirboosted protease inhibitor (atazanavir or darunavir), or an integrase strand transfer inhibitor (raltegravir). Alternatives in each class are recommended for patients with or at risk of certain concurrent conditions. CD4 cell count and HIV-1 RNA level should be monitored, as should engagement in care, ART adherence, HIV drug resistance, and quality-of-care indicators. Reasons for regimen switching include virologic, immunologic, or clinical failure and drug toxicity or intolerance. Confirmed treatment failure should be addressed promptly and multiple factors considered. Conclusion: New recommendations for HIV patient care include offering ART to all patients regardless of CD4 cell count, changes in therapeutic options, and modifications in the timing and choice of ART in the setting of opportunistic illnesses such as cryptococcal disease and tuberculosis.",
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