Treatment for adult HIV infection: 2004 recommendations of the International AIDS Society-USA Panel.
BACKGROUND
Substantial changes in the field of human immunodeficiency virus (HIV) treatment have occurred in the last 2 years, prompting revision of the guidelines for antiretroviral management of adults with established HIV infection.


OBJECTIVE
To update recommendations for physicians who provide HIV care regarding when to start antiretroviral therapy, what drugs to start with, when to change drug regimens, and what drug regimens to switch to after therapy fails.


METHODS
Evidence was identified and reviewed by a 16-member noncompensated panel of physicians with expertise in HIV-related basic science and clinical research, antiretroviral therapy, and HIV patient care. The panel was designed to have broad US and international representation for areas with adequate access to antiretroviral management.


METHODS
Evidence considered included published basic science, clinical research, and epidemiological data (identified by experts in the field or extracted through MEDLINE searches using terms relevant to antiretroviral therapy) and abstracts from HIV-oriented scientific conferences between July 2002 and May 2004.


METHODS
Data were reviewed to identify any information that might change previous guidelines. Based on panel discussion, guidelines were drafted by a writing committee and discussed by the panel until consensus was reached.


RESULTS
Four antiretroviral drugs recently have been made available and have broadened the options for initial and subsequent regimens. New data allow more definitive recommendations for specific drugs or regimens to include or avoid, particularly with regard to initial therapy. Recommendations are rated according to 7 evidence categories, ranging from I (data from prospective randomized clinical trials) to VII (expert opinion of the panel).


CONCLUSIONS
Further insights into the roles of drug toxic effects, drug resistance, and pharmacological interactions have resulted in additional guidance for strategic approaches to antiretroviral management.
Yeni
Patrick G
PG
Department of Infectious Diseases, Hôpital Bichat-Claude Bernard, X. Bichat Medical School, Paris, France. Patrick.Yeni@Bch.Ap-Hop-Paris.Fr
Hammer
Scott M
SM
Hirsch
Martin S
MS
Saag
Michael S
MS
Schechter
Mauro
M
Carpenter
Charles C J
CC
Fischl
Margaret A
MA
Gatell
Jose M
JM
Gazzard
Brian G
BG
Jacobsen
Donna M
DM
Katzenstein
David A
DA
Montaner
Julio S G
JS
Richman
Douglas D
DD
Schooley
Robert T
RT
Thompson
Melanie A
MA
Vella
Stefano
S
Volberding
Paul A
PA
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000592:standards*; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D019562:Viral Load
D019380:Anti-HIV Agents