Guidelines for using antiretroviral agents among HIV-infected adults and adolescents: The panel on clinical practices for treatment of HIV

Mark Dybul, Anthony S. Fauci, John Bartlett, Jonathan E. Kaplan, Alice K. Pau

Research output: Contribution to journalArticle

Abstract

The availability of an increasing number of antiretroviral agents and the rapid evolution of new information have introduced substantial complexity into treatment regimens for persons infected with human immunodeficiency virus (HIV). In 1996, the Department of Health and Human Services and the Henry J. Kaiser Family Foundation convened the Panel on Clinical Practices for the Treatment of HIV to develop guidelines for clinical management of HIV-infected adults and adolescents (CDC. Report of the NIH Panel To Define Principles of Therapy of HIV Infection and Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. MMWR. 1998;47[RR-5]:1-41). This report, which updates the 1998 guidelines, addresses 1) using testing for plasma HIV ribonucleic acid levels (i.e., viral load) and CD4+ T cell count; 2) using testing for antiretroviral drug resistance; 3) considerations for when to initiate therapy; 4) adherence to antiretroviral therapy; 5) considerations for therapy among patients with advanced disease; 6) therapy-related adverse events; 7) interruption of therapy; 8) considerations for changing therapy and available therapeutic options; 9) treatment for acute HIV infection; 10) considerations for antiretroviral therapy among adolescents; 11) considerations for antiretroviral therapy among pregnant women; and 12) concerns related to transmission of HIV to others. Antiretroviral regimens are complex, have serious side effects, pose difficulty with adherence, and carry serious potential consequences from the development of viral resistance because of nonadherence to the drug regimen or suboptimal levels of antiretroviral agents. Patient education and involvement in therapeutic decisions are critical. Treatment should usually be offered to all patients with symptoms ascribed to HIV infection. Recommendations for offering antiretroviral therapy among asymptomatic patients require analysis of real and potential risks and benefits. In general, treatment should be offered to persons who have + T cells/mm3 or plasma HIV ribonucleic acid (RNA) levels of >55,000 copies/mL (by b-deoxyribonucleic acid [bDNA] or reverse transcriptase-polymerase chain reaction [RT-PCR] assays). The recommendation to treat asymptomatic patients should be based on the willingness and readiness of the person to begin therapy; the degree of existing immunodeficiency as determined by the CD4+ T cell count; the risk for disease progression as determined by the CD4+ T cell count and level of plasma HIV RNA; the potential benefits and risks of initiating therapy in an asymptomatic person; and the likelihood, after counseling and education, of adherence to the prescribed treatment regimen. Treatment goals should be maximal and durable suppression of viral load, restoration and preservation of immunologic function, improvement of quality of life, and reduction of HIV-related morbidity and mortality. Results of therapy are evaluated through plasma HIV RNA levels, which are expected to indicate a 1.0 log10 decrease at 2-8 weeks and no detectable virus (

Original languageEnglish (US)
Pages (from-to)381-433
Number of pages53
JournalAnnals of Internal Medicine
Volume137
Issue number5 II
StatePublished - Sep 3 2002
Externally publishedYes

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Anti-Retroviral Agents
HIV
Guidelines
Therapeutics
Virus Diseases
CD4 Lymphocyte Count
RNA
T-Lymphocytes
Viral Load

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Guidelines for using antiretroviral agents among HIV-infected adults and adolescents : The panel on clinical practices for treatment of HIV. / Dybul, Mark; Fauci, Anthony S.; Bartlett, John; Kaplan, Jonathan E.; Pau, Alice K.

In: Annals of Internal Medicine, Vol. 137, No. 5 II, 03.09.2002, p. 381-433.

Research output: Contribution to journalArticle

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