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New, promising era dawns for patients with drug-resistant HIV.

TORONTO -- The new goal of therapy for HIV-infected adults who have repeatedly failed several drug regimens should be to decrease their viral load to undetectable levels with new drug regimens, according to updated guidelines announced at the 16th International AIDS Conference.

"The management of highly treatment-experienced individuals who are experiencing their third, fourth, or even fifth failure with multi-drug-resistant virus and three-class drug experience now includes the use of appropriate new drug regimens which can reduce their viral load to under 50 copies of HIV RNA per milliliter of blood," Dr. Scott M. Hammer, Harold C. Neu Professor of Medicine, professor of epidemiology, and chief of the division of infectious diseases at Columbia University Medical Center, New York, said.

Physicians used to settle for CD4+ cell counts in a higher range. "While we still have to settle for that in some individuals, our first attempt is to really drive their virus down to undetectable levels, and that's a new era," said Dr. Hammer, lead author of the new guidelines issued by the International AIDS Society-USA Panel.

He estimated that as many as two-thirds of HIV-infected individuals who are refractory to current regimens can benefit from the newer drugs that have emerged since the panel published its last guidelines 2 years ago.

"The approval of the protease inhibitor darunavir and the fusion inhibitor enfuviritide ... can give us a good chance of reducing our patients' viral load to under 50 copies, especially when combined with other agents," he said.

The International AIDS Society-USA Panel, which is not related to the International AIDS Society, is made up of 16 members who represent countries in the developed world. The panel's recommendations are geared for areas where there is no restriction of resources to treat AIDS, and were derived after a review of data published or presented at scientific conferences from mid-2004 through May 2006.

Other key AIDS-USA recommendations include:

* Treatment in symptomatic and asymptomatic patients when CD4 cell count falls below 350/[micro]L but before it declines to 200/[micro]L.

* Initial regimen remains a combination of two nucleoside (or nucleotide) reverse transcriptase inhibitors (nRTIs) with either a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI) with low-dose ritonavir.

* Choice of therapy should be based on the individual patient profile.

* Therapy should be changed when toxicity, intolerance, or documented treatment failure occurs.

* Adherence to therapy in both the short and long term is crucial for treatment success and must be continually reinforced.

The 2006 Recommendations of the International AIDS Society-USA Panel were published in the Journal of the American Medical Association (JAMA 2006;296:827-43).


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Author:Lowry, Fran
Publication:Internal Medicine News
Geographic Code:1CANA
Date:Sep 15, 2006
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