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'Start HIV Therapy Earlier, IAS-USA Panel Recommends'
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Antiretroviral Treatment of Adult HIV Infection
2010 Recommendations of the International AIDS Society-USA Panel
Primary source: Journal of the American Medical Association
Source reference:
Thompson MA, et al "Antiretroviral treatment of adult HIV infection: 2010 Recommendations of the International AIDS Society-USA Panel" JAMA 2010; 304(3): 321-333.
JAMA July 21 2010
"Conclusions Patient readiness for treatment should be confirmed before initiation of antiretroviral treatment. Therapy is recommended for asymptomatic patients with a CD4 cell count of 500/µL or less, for all symptomatic patients, and those with specific conditions and comorbidities. Therapy should be considered for asymptomatic patients with CD4 cell count >500/µL. Components of the initial and subsequent regimens must be individualized, particularly in the context of concurrent conditions. Patients receiving antiretroviral treatment should be monitored regularly; treatment failure should be detected and managed early, with the goal of therapy, even in heavily pretreated patients, being HIV-1 RNA suppression below commercially available assay quantification limits."
"Increasing evidence that insidious damage occurs during "asymptomatic" HIV infection underscores the potential benefit of ART, even when the risk of traditional AIDS-defining diseases is relatively low. 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 strategic use of newer drugs can improve tolerability, as well as provide durable and potent viral suppression in initial and subsequent therapy.
However, 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. 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."
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