New HIV Guideline Limits Recommended Regimens

New HIV treatment guidelines were released by the US Department of Health and Human Services.

The guidelines listed several major changes including a more focused list of recommended regimens for antiretroviral therapy (ART); the 5 recommendations are TDF/FTC plus DTG or EVG/c or RAL, ABC/3TC/DTG, and TDF/FTC plus DRV/r(5).
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Further, there are new classifications for the regimens limited to patients with low HIV RNA: TDF/FTC/RPV is known as alternative, while ABC/3TC plus EFV, ABC/3TC plus ATV/r is known as other.

In terms of virologic failure, a new subsection on Isolated CNS Virologic Failure and New Onset Neurologic Symptoms was added, while the Management of Virologic Failure in Different Clinical Scenarios subsection has been expanded to provide management guidelines for patients who failed the first and second ART regimens.

Other changes include:

Acute/Early HIV Infection
•    The 2014 Centers for Disease Control and Prevention’s recommendation for HIV infection diagnosis—including those with early or acute infection—has been included in this section.

HIV-2 Infection
•    The section was updated with recent ARV literature explaining use in HIV-2 infected individuals

Poor CD4 Cell Recovery and Persistent Inflammation Despite Viral Suppression
•    The new section details the role of chronic low CD4 cell counts (<200 cells/mm3) and inflammation and immune activation and their increase on Non-AIDS-related and AIDS-related morbidity.
•    There is greater emphasis on the lack of health improvements from therapeutic intervention created to improve CD4 cell recovery or immune activation.

Drug Interaction
•    The text of this section of the guidelines has been updated with a focus on the mechanisms of interaction for ARV drugs.
•    All of the Drug Interaction tables have been updated and a new table (Table 17) has been developed to give more information on clinically relevant mechanisms of antiretroviral associated drug interactions.

The complete guidelines were published on the NIH website, http://aidsinfo.nih.gov/guidelines.

-Michelle Canales Butcher

Reference:

National Institute of Health. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. http://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/0. Updated April 8, 2015. Accessed April 10, 2015.