title: Antiretroviral treatment of adult HIV infection: 2014 recommendations of the International Antiviral Society-USA Panel.
abstract: OBJECTIVE
  New data and antiretroviral regimens expand treatment choices in resource-rich settings and warrant an update of recommendations to treat adults infected with human immunodeficiency virus (HIV).
  
  
  OBJECTIVE
  To provide updated treatment recommendations for adults with HIV, emphasizing when to start treatment; what treatment to start; the use of laboratory monitoring tools; and managing treatment failure, switches, and simplification.
  
  
  METHODS
  An International Antiviral Society-USA panel of experts in HIV research and patient care considered previous data and reviewed new data since the 2012 update with literature searches in PubMed and EMBASE through June 2014. Recommendations and ratings were based on the quality of evidence and consensus.
  
  
  RESULTS
  Antiretroviral therapy is recommended for all adults with HIV infection. Evidence for benefits of treatment and quality of available data increase at lower CD4 cell counts. Recommended initial regimens include 2 nucleoside reverse transcriptase inhibitors (NRTIs; abacavir/lamivudine or tenofovir disoproxil fumarate/emtricitabine) and a third single or boosted drug, which should be an integrase strand transfer inhibitor (dolutegravir, elvitegravir, or raltegravir), a nonnucleoside reverse transcriptase inhibitor (efavirenz or rilpivirine) or a boosted protease inhibitor (darunavir or atazanavir). Alternative regimens are available. Boosted protease inhibitor monotherapy is generally not recommended, but NRTI-sparing approaches may be considered. New guidance for optimal timing of monitoring of laboratory parameters is provided. Suspected treatment failure warrants rapid confirmation, performance of resistance testing while the patient is receiving the failing regimen, and evaluation of reasons for failure before consideration of switching therapy. Regimen switches for adverse effects, convenience, or to reduce costs should not jeopardize antiretroviral potency.
  
  
  CONCLUSIONS
  After confirmed diagnosis of HIV infection, antiretroviral therapy should be initiated in all individuals who are willing and ready to start treatment. Regimens should be selected or changed based on resistance test results with consideration of dosing frequency, pill burden, adverse toxic effect profiles, comorbidities, and drug interactions.
authors.affiliation: University Hospital Zurich, Zurich, Switzerland.
authors.forename: Huldrych F
authors.initials: HF
authors.lastname: Günthard
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Aberg
authors.affiliation: University of North Carolina School of Medicine, Chapel Hill.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
authors.affiliation: Alfred Hospital and Monash University, Melbourne, Australia.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Hoy
authors.affiliation: University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Amalio
authors.initials: A
authors.lastname: Telenti
authors.affiliation: University of California School of Medicine, San Diego.
authors.forename: Constance A
authors.initials: CA
authors.lastname: Benson
authors.affiliation: Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: David M
authors.initials: DM
authors.lastname: Burger
authors.affiliation: Hospital Juan Fernandez/University of Buenos Aires Medical School and Fundacion Huesped, Buenos Aires, Argentina.
authors.forename: Pedro
authors.initials: P
authors.lastname: Cahn
authors.affiliation: Southwest CARE Center, Santa Fe, New Mexico.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Gallant
authors.affiliation: Weill Cornell Medical College, New York, New York.
authors.forename: Marshall J
authors.initials: MJ
authors.lastname: Glesby
authors.affiliation: Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: David L
authors.initials: DL
authors.lastname: Thomas
authors.affiliation: International Antiviral Society-USA, San Francisco, California.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Jacobsen
authors.affiliation: University of California, San Francisco.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Volberding
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D016527:Drug Costs; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D017211:Treatment Failure
chemical_list: D019380:Anti-HIV Agents