Treatment for adult HIV infection: 2006 recommendations of the International AIDS Society-USA panel.
BACKGROUND
Guidelines for antiretroviral therapy are important for clinicians worldwide given the complexity of the field and the varied clinical situations in which these agents are used. The International AIDS Society-USA panel has updated its recommendations as warranted by new developments in the field.


OBJECTIVE
To provide physicians and other human immunodeficiency virus (HIV) clinicians with current recommendations for the use of antiretroviral therapy in HIV-infected adults in circumstances for which there is relatively unrestricted access to drugs and monitoring tools. The recommendations are centered on 4 key issues: when to start antiretroviral therapy; what to start; when to change; and what to change. Antiretroviral therapy in special circumstances is also described.


METHODS
A 16-member noncompensated panel was appointed, based on expertise in HIV research and patient care internationally. Data published or presented at selected scientific conferences from mid 2004 through May 2006 were identified and reviewed by all members of the panel.


METHODS
Data that might change previous guidelines were identified and reviewed. New guidelines were drafted by a writing committee and reviewed by the entire panel.


CONCLUSIONS
Antiretroviral therapy in adults continues to evolve rapidly, making delivery of state-of-the-art care challenging. Initiation of therapy continues to be recommended in all symptomatic persons and in asymptomatic persons after the CD4 cell count falls below 350/microL and before it declines to 200/microL. A nonnucleoside reverse transcriptase inhibitor or a protease inhibitor boosted with low-dose ritonavir each combined with 2 nucleoside (or nucleotide) reverse transcriptase inhibitors is recommended with choice being based on the individual patient profile. Therapy should be changed when toxicity or intolerance mandate it or when treatment failure is documented. The virologic target for patients with treatment failure is now a plasma HIV-1 RNA level below 50 copies/mL. Adherence to antiretroviral therapy in the short-term and the long-term is crucial for treatment success and must be continually reinforced.
Hammer
Scott M
SM
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. smh48@columbia.edu
Saag
Michael S
MS
Schechter
Mauro
M
Montaner
Julio S G
JS
Schooley
Robert T
RT
Jacobsen
Donna M
DM
Thompson
Melanie A
MA
Carpenter
Charles C J
CC
Fischl
Margaret A
MA
Gazzard
Brian G
BG
Gatell
Jose M
JM
Hirsch
Martin S
MS
Katzenstein
David A
DA
Richman
Douglas D
DD
Vella
Stefano
S
Yeni
Patrick G
PG
Volberding
Paul A
PA
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000592:standards; D016903:Drug Monitoring; D024882:Drug Resistance, Viral; D005260:Female; D006678:HIV / Q000187:drug effects / Q000235:genetics; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D014376:Tuberculosis / Q000150:complications; D019562:Viral Load