New Guidelines Urge Earlier Therapy for HIV Patients

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SUNDAY, July 18 (HealthDay News) -- Starting antiretroviral treatment (ART) when an HIV patient has no symptoms can prevent the progressive immune system destruction that leads to AIDS, according to new treatment guidelines released by the International AIDS Society-USA Panel.

The 2010 recommendations were written by a panel of experts who reviewed new HIV data and research on timing of therapy, optimal regimen choices and monitoring that has emerged since the publication of the 2008 guidelines. There's also now more knowledge about the effectiveness, toxicity and potential uses of newer drugs in HIV management.

"The prominence of non-AIDS events as a major cause of morbidity and mortality in those with ongoing HIV replication suggests that early ART initiation may further improve the quality and length of life for persons living with HIV," the panel members wrote.

Patient readiness is a key consideration when doctors are deciding to prescribe ART and there is no CD4 cell count level that would prevent the initiation of therapy, they added.

CD4 cells are immune system cells targeted by HIV, so concentrations (counts) of CD4 in blood are a key indicator of disease progression.

According to the new guidelines:

• ART is recommended for patients without symptoms with CD4 cell counts at 500 cells or less per microliter.
• ART should be considered for patients without symptoms with CD4 cell counts greater than 500 per microliter and is recommended regardless of CD4 cell counts for patient who have established HIV disease with symptoms.
• ART is also recommended for patients who are pregnant, older than 60, or have an active or high risk for cardiovascular disease, and for those with hepatitis B or C infections, HIV-associated kidney disease, opportunistic diseases or symptomatic primary HIV infection.
• ART should also be prescribed in cases where there is a high risk for HIV transmission, such as couples with one HIV-infected and one HIV-free partner.
• Once started, ART should be continued, except when being used in a clinical trial.
• Risk-reduction counseling should be a routine part of care.

The new guidelines are scheduled for presentation at the International AIDS Conference in Vienna on Sunday and will be published in the July 21 HIV/AIDS theme issue of the Journal of the American Medical Association.

"Far too many HIV-infected persons present for medical care with advanced disease, both in wealthy and resource-limited settings. Universal voluntary HIV testing, comprehensive prevention services, and early linkage to care and treatment are necessary to ensure that advances in ART are made available during earlier disease stages," the authors of the report wrote.

"Advances in ART have shown that AIDS, as traditionally defined, can be prevented. One of the greatest challenges is that full implementation of these guidelines will require addressing social and structural barriers to diagnosis and care, as well as the pervasive stigma and discrimination associated with an HIV diagnosis," they concluded.

-- Robert Preidt

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SOURCE: Journal of the American Medical Association, news release, July 18, 2010