Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society-USA panel.
BACKGROUND
Recent data regarding the consequences of untreated human immunodeficiency virus (HIV) infection and the expansion of treatment choices for antiretroviral-naive and antiretroviral-experienced patients warrant an update of the International AIDS Society-USA guidelines for the use of antiretroviral therapy in adults with HIV infection.


OBJECTIVE
To provide updated recommendations for management of HIV-infected adults, using antiretroviral drugs and laboratory monitoring tools available in the international, developed-world setting. This report provides guidelines for when to initiate antiretroviral therapy, selection of appropriate initial regimens, patient monitoring, when to change therapy, and what regimens to use when changing.


METHODS
A panel with expertise in HIV research and clinical care reviewed relevant data published or presented at selected scientific conferences since the last panel report through April 2010. Data were identified through a PubMed search, review of scientific conference abstracts, and requests to antiretroviral drug manufacturers for updated clinical trials and adverse event data.


METHODS
New evidence was reviewed by the panel. Recommendations were drafted by section writing committees and reviewed and edited by the entire panel. The quality and strength of the evidence were rated and recommendations were made by full panel consensus.


CONCLUSIONS
Patient readiness for treatment should be confirmed before initiation of antiretroviral treatment. Therapy is recommended for asymptomatic patients with a CD4 cell count < or = 500/microL, for all symptomatic patients, and those with specific conditions and comorbidities. Therapy should be considered for asymptomatic patients with CD4 cell count > 500/microL. Components of the initial and subsequent regimens must be individualized, particularly in the context of concurrent conditions. Patients receiving antiretroviral treatment should be monitored regularly; treatment failure should be detected and managed early, with the goal of therapy, even in heavily pretreated patients, being HIV-1 RNA suppression below commercially available assay quantification limits.
Thompson
Melanie A
MA
AIDS Research Consortium of Atlanta, Atlanta, Georgia, USA. drmt@mindspring.com
Aberg
Judith A
JA
Cahn
Pedro
P
Montaner
Julio S G
JS
Rizzardini
Giuliano
G
Telenti
Amalio
A
Gatell
José M
JM
Günthard
Huldrych F
HF
Hammer
Scott M
SM
Hirsch
Martin S
MS
Jacobsen
Donna M
DM
Reiss
Peter
P
Richman
Douglas D
DD
Volberding
Paul A
PA
Yeni
Patrick
P
Schooley
Robert T
RT
D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D004334:Drug Administration Schedule; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D012367:RNA, Viral / Q000097:blood; D017211:Treatment Failure; D019562:Viral Load
D044966:Anti-Retroviral Agents; D012367:RNA, Viral