Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents
Published Date:February 12, 2013
Corporate Authors:Panel on Clinical Practices for the Treatment of HIV Infection (U.S.) ; Centers for Disease Control and Prevention (U.S.) ; National Institutes of Health (U.S.). Office of AIDS Research. Advisory Council.
Anti-HIV Agents/adverse Effects
Anti-HIV Agents/therapeutic Use
Antiretroviral Therapy, Highly Active/adverse Effects
Antiretroviral Therapy, Highly Active/standards
Drug Resistance, Viral
HIV Infections/drug Therapy
Pregnancy Complications, Infectious/drug Therapy
Description:What’s new in the guidelines -- Panel roster -- Financial disclosure -- Introduction -- Baseline evaluation -- Laboratory testing -- Treatment goals -- Initiating antiretroviral therapy in treatment-naive patients -- What to start -- What not to use -- Management of the treatment-experienced patient -- Considerations for antiretroviral use in special patient populations -- Considerations for antiretroviral use in patients with coinfections -- Limitations to treatment safety and efficacy -- Drug interactions -- Preventing secondary transmission of HIV -- Conclusion -- Appendix A: Key to acronyms -- Appendix B: Drug characteristics tables -- List of tables.
Antiretroviral therapy (ART) for the treatment of HIV infection has improved steadily since the advent of potent combination therapy in 1996. New drugs that offer new mechanisms of action, improvements in potency and activity even against multidrug-resistant viruses, dosing convenience, and tolerability have been approved. ART has dramatically reduced HIV-associated morbidity and mortality and has transformed HIV disease into a chronic, manageable condition. In addition, effective treatment of HIV-infected individuals with ART is highly effective at preventing transmission to sexual partners.1 However, less than one-third of HIV-infected individuals in the United States have suppressed viral loads,2 which is mostly a result of undiagnosed HIV infection and failure to link or retain diagnosed patients in care. Despite remarkable improvements in HIV treatment and prevention, economic and social barriers that result in continued morbidity, mortality, and new HIV infections persist.
The Department of Health and Human Services (HHS) Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel) is a working group of the Office of AIDS Research Advisory Council (OARAC). The primary goal of the Panel is to provide HIV care practitioners with recommendations based on current knowledge of antiretroviral (ARV) drugs used to treat adults and adolescents with HIV infection in the United States. The Panel reviews new evidence and updates recommendations in these guidelines when needed. The Panel’s primary areas of attention have included baseline assessment, treatment goals, indications for initiation of ART, choice of the initial regimen for ART-naive patients, drugs or combinations to avoid, management of adverse effects and drug interactions, management of treatment failure, and special ART-related considerations in specific patient populations.
These guidelines generally represent the state of knowledge regarding the use of ARV agents. However, because the science of HIV evolves rapidly, the availability of new agents and new clinical data may change therapeutic options and preferences. Information included in these guidelines may not be consistent with approved labeling for the particular products or indications in question, and the use of the terms “safe” and “effective” may not be synonymous with the Food and Drug Administration (FDA)-defined legal standards for product approval. The Panel frequently updates the guidelines (current and archived versions of the guidelines are available on the AIDSinfo website at http://www.aidsinfo.nih.gov). However, the guidelines cannot always be updated apace with the rapid evolution of new data in the field of HIV and cannot offer guidance on care for all patients. Clinicians should exercise clinical judgment in management decisions tailored to unique patient circumstances.
The Panel recognizes the importance of clinical research in generating evidence to address unanswered questions related to the optimal safety and efficacy of ART. The Panel encourages both the development of protocols and patient participation in well-designed, Institutional Review Board (IRB)-approved clinical trials.
These Guidelines were developed by the Department of Health and Human Services (HHS) Panel on Antiretroviral Guidelines for Adults and Adolescents (a Working Group of the Office of AIDS Research Advisory Council).
Suggested citation: Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
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