Obtaining the New HIV Treatment Guidelines.

The new Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents were released February 5; they are available at many Web sites, but the official site for all the U.S. Department of Health and Human Services HIV treatment guidelines is the HI V/AIDS Treatment Information Service, http://www.hivatis. org.

For a printed copy, you can call 800-448-0440, or mail a request to HIV/AIDS Treatment Information Service, P.O. Box 6303, Rockville, MD 20849-6303. Note: it will probably take the office 7-10 days to ship a printed copy of the guidelines -- in addition to the time required for mail delivery. Be sure to ask for the adult guidelines if that is what you want, as there are currently five different HIV guidelines available (see below).

The official Web site (http://www.hivatis.org) also has a separate copy of the new adult guidelines with changes highlighted in yellow, so you can see what is different from the last version.

When we checked this site in March 2001, the guidelines could either be viewed while online or printed; however, we were unable to save a copy of the file for viewing on the computer when not connected to the Internet. A dial-up (low speed) connection did work OK for viewing. When we checked, the HTML (Web) format version had a summary of the changes, which was not included in the PDF format or printed document.

What Has Changed?

The most prominent change is that the new guidelines are more conservative about when to start treatment.

"In general, treatment should be offered to individuals with fewer than 350 CD4+ T cells/mm3 or plasma HIV RNA levels exceeding 30,000 copies/mL (bDNA assay) or 55,000 copies/mL (RT-PCR assay). The strength of the recommendation to treat asymptomatic patients should be based on the willingness and readiness of the individual to begin therapy; the degree of existing immunodeficiency as determined by the CD4+ T cell count; the risk of disease progression as determined by the CD4+ T cell count and level of plasma HIV RNA; the potential benefits and risks of initiating therapy in asymptomatic individuals; and the likelihood, after counseling and education, of adherence to the prescribed treatment regimen." (From the Summary. This discussion does not apply to all patients -- see the full Summary.)

There is also a new section in this edition of the adult treatment guidelines, "Considerations for Antiretroviral Therapy in Women."

Since most HIV physicians were already treating in accordance with the new guidelines even before their publication, this recommendation is not expected to change HIV practice very much. More important to day-by-day medical care will be the extensive practical information for physicians, which has been provided in 24 tables in the document. The guidelines committee presented this information as tables because members thought physicians would be more likely to use it in that form than if presented as text.

Other Guidelines Available

Besides the adult guidelines, the HIV/AIDS Treatment Information Service can send current guidelines on:

* Prevention of opportunistic infections;

* Treatment of HIV in children;

* Prevention of mother-to-child transmission; and

* Recommendations for healthcare workers exposed to HIV.

The office also has other patient education material.

Getting Your Questions Answered

The HIV/AIDS Treatment Information Service can answer individual questions, either by phone or by postal mail address above, or by email to [e-mail]. It can provide information from its database, but of course cannot give medical advice.