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Updated European (EACS) & USA Treatment Guidelines (DHHS)
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Reported by Jules Levin
The highline differences between the 2 updated Guidelines regarding When To Begin and What to Begin focus on 3 items: (1) raltegravir has been added as a firstline preferred option in USA giudelines but not in EACS, (2) starting HAART at 350-500 is recommended in USA guideline although the strength of the recommendation is mixed (55% of panelists voted for a strong recommendation, 45% for a moderate strength recommndation), and they suggest starting at >500 is an option, but not in EACS guidelines although EACS says you can consider it if patient seeks it & is ready, (3) abacavir is still on recommended list in EACS.
Below the link are pictures of the tables in the new EACS ART Treatment Guidelines issued last week in Cologne on When To Begin & What To Begin with. So what are the differences between the US & European guidelines on these 2 questions? EACS says when CD4 is 350-500 "treatment recommended if HCV coinfection, HBV coinfection requiring therapy, HIV-associated nephropathy or other organ specific deficiency, but HAART should be considered if viral load is >100,000 and/or CD4 decline >50-100/year or age >50, or pregnancy, high CVD risk, malignancy. If CD4>500 HAART should be deferred, independently of HIV RNA >100,000, closer followup of CD4 if viral load is >100,000; HAART can be offered if 1 or more of the above mentioned co-morbid conditions are present (CD4 350-500); whatever CD4 and viral load HAART can be offered if patient is seeking and ready for therapy. Apparently abacavir/3TC is still on the recommended list in EACS Guidelines. Raltegravir has now been added as a firstline preferred option in the USA guidelines but it was still an alternative option in EACS guidelines.
EACS: New EACS (European AIDS Clinical Society) HIV Guidelines: HIV treatment, comorbidities (prevention and management of metabolic diseases), management and treatment of chronic hepatitis B and C coinfection in HIV+
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New EACS Guidelines
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