Monday, April 25, 2016

Updated Treatment Guidelines: Stronger Support for Starting Early

The newly updated Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents, released February 12, 2013, by the Department of Health and Human Services, recommends offering treatment to people with “early infection,” defined as infection that occurred within the past six months. This includes the initial acute infection stage, when the virus is rapidly reproducing in the body but may not yet be discovered by routine HIV antibody tests.
The recommendation for starting antiretroviral therapy in people with early infection was strengthened from “should be considered optional” to “should be offered.”
See “Early Treatment Cuts Infection of Resting CD4 Cells” to learn more about acute infection—and why researchers hope starting HIV therapy early may help eradicate the virus.
The updated guidelines continue to advise treatment for all HIV-positive individuals, regardless of CD4 cell count (a key measure of immune function), both to preserve and improve the HIV-positive individuals’ health and to protect their sex partners. “Clinicians should also inform patients that viral suppression from effective ART [antiretroviral therapy] can reduce the risk of sexual transmission to others,” the guidelines state.
That said, the update acknowledges “patient readiness” as a crucial factor in the decision to begin life-long antiretroviral therapy. “Patients starting ART should be willing and able to commit to treatment and understand the benefits and risks of therapy and the importance of adherence,” the guidelines emphasize. “Patients may choose to postpone therapy, and providers, on a case-by-case basis, may elect to defer therapy on the basis of clinical and/or psychosocial factors.”
Thinking about starting HIV treatment? See “Resource Round-Up: Starting Meds for the First Time” to get tips and tools for finding the right regimen and making it work for you.
Additional changes address testing for drug-resistance mutations, screening for HIV “tropism” (essential before starting a regimen that includes the CCR5-antagonist drug maraviroc [Selzentry]), and new information about drug interactions, as well as special considerations for pregnant women and for people beginning HIV treatment for the first time.
A summary of the changes is available here. To read the updated guidelines yourself and learn about the studies and reports that informed these changes, click here.
Reilly O’Neal is a freelance writer and former editor of BETA.
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