title: Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 ritonavir-boosted 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.
  
  
  CONCLUSIONS
  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.
authors: AIDS Research Consortium of Atlanta, 131 Ponce de Leon Ave NE, Ste 130, Atlanta, GA 30308, USA. drmt@mindspring.com
authors: Melanie A
authors: MA
authors: Thompson
authors: Judith A
authors: JA
authors: Aberg
authors: Jennifer F
authors: JF
authors: Hoy
authors: Amalio
authors: A
authors: Telenti
authors: Constance
authors: C
authors: Benson
authors: Pedro
authors: P
authors: Cahn
authors: Joseph J
authors: JJ
authors: Eron
authors: Huldrych F
authors: HF
authors: Günthard
authors: Scott M
authors: SM
authors: Hammer
authors: Peter
authors: P
authors: Reiss
authors: Douglas D
authors: DD
authors: Richman
authors: Giuliano
authors: G
authors: Rizzardini
authors: David L
authors: DL
authors: Thomas
authors: Donna M
authors: DM
authors: Jacobsen
authors: Paul A
authors: PA
authors: Volberding
mesh_terms: D017088:AIDS-Related Opportunistic Infections; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008297:Male; D055118:Medication Adherence; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D011787:Quality of Health Care; D012367:RNA, Viral / Q000097:blood; D012955:Societies, Medical; D017211:Treatment Failure
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral