title: French 2013 guidelines for antiretroviral therapy of HIV-1 infection in adults.
abstract: BACKGROUND
  These guidelines are part of the French Experts' recommendations for the management of people living with HIV/AIDS, which were made public and submitted to the French health authorities in September 2013. The objective was to provide updated recommendations for antiretroviral treatment (ART) of HIV-positive adults. Guidelines included the following topics: when to start, what to start, specific situations for the choice of the first session of antiretroviral therapy, optimization of antiretroviral therapy after virologic suppression, and management of virologic failure.
  
  
  METHODS
  Ten members of the French HIV 2013 expert group were responsible for guidelines on ART. They systematically reviewed the most recent literature. The chairman of the subgroup was responsible for drafting the guidelines, which were subsequently discussed within, and finalized by the whole expert group to obtain a consensus. Recommendations were graded for strength and level of evidence using predefined criteria. Economic considerations were part of the decision-making process for selecting preferred first-line options. Potential conflicts of interest were actively managed throughout the whole process.
  
  
  RESULTS
  ART should be initiated in any HIV-positive person, whatever his/her CD4 T-cell count, even when >500/mm3. The level of evidence of the individual benefit of ART in terms of mortality or progression to AIDS increases with decreasing CD4 cell count. Preferred initial regimens include two nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine or abacavir/lamivudine) plus a non-nucleoside reverse transcriptase inhibitor (efavirenz or rilpivirine), or a ritonavir-boosted protease inhibitor (atazanavir or darunavir). Raltegravir, lopinavir/r, and nevirapine are recommended as alternative third agents, with specific indications and restrictions. Specific situations such as HIV infection in women, primary HIV infection, severe immune suppression with or without identified opportunistic infection, and person who injects drugs are addressed. Options for optimization of ART once virologic suppression is achieved are discussed. Evaluation and management of virologic failure are described, the aim of any intervention in such situation being to reduce plasma viral load to <50 copies/ml.
  
  
  CONCLUSIONS
  These guidelines recommend that any HIV-positive individual should be treated with ART. This recommendation was issued both for the patient's own sake and for promoting treatment as prevention.
authors.affiliation: Service de maladies infectieuses, Centre Hospitalier Universitaire, Pointe-à Pitre, France; bruno.hoen@chu-guadeloupe.fr.
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
authors.affiliation: Service de médecine interne et maladies infectieuses, Centre Hospitalier Universitaire, Bordeaux, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonnet
authors.affiliation: Laboratoire de virologie, Hôpital Saint Louis, Assistance Publique des hôpitaux de Paris, Paris, France.
authors.forename: Constance
authors.initials: C
authors.lastname: Delaugerre
authors.affiliation: Service des maladies infectieuses et tropicales, Centre Hospitalier Universitaire, Toulouse, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Delobel
authors.affiliation: Service de médecine interne, Hôpital du Kremlin-Bicêtre, Assistance Publique des hôpitaux de Paris, Paris, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Goujard
authors.affiliation: Groupe interassociatif traitement et recherche thérapeutique (TRT-5), Association ARCAT, Paris, France.
authors.forename: Marianne
authors.initials: M
authors.lastname: L'Hénaff
authors.affiliation: Groupe interassociatif traitement et recherche thérapeutique (TRT-5), Association AIDES, Paris, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Persiaux
authors.affiliation: Centre d'information et de soins de l'immunodéficience humaine, Hôpitaux universitaires, Strasbourg, France.
authors.forename: David
authors.initials: D
authors.lastname: Rey
authors.affiliation: Laboratoire de virologie, Hôpital Necker-Enfants malades, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Rouzioux
authors.affiliation: Laboratoire de pharmacologie, Hôpital du Kremlin-Bicêtre, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Taburet
authors.affiliation: Service de médecine interne et maladies infectieuses, Centre Hospitalier Universitaire, Bordeaux, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morlat
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000592:standards; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D005602:France; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: antiretroviral treatment; cost of treatment; first-line therapy; guidelines; virologic failure