HIV Treatment Should Begin as Early as Possible

uly 22, 2012 (Washington, DC) — New recommendations for antiretroviral therapy (ART), issued here on opening day of AIDS 2012: XIX International AIDS Conference, say that ART should be offered to all adult patients who are HIV-positive as soon as possible, regardless of CD4 cell count.

The earlier it is offered, the better the outcome, Melanie A. Thompson, MD, of the AIDS Research Consortium of Atlanta, Georgia, told meeting delegates. Dr. Thompson headed the 2012 Recommendations of the International Antiviral Society–USA Panel (IAS-USA). Their conclusions are in a special edition of the Journal of the American Medical Association, to be published July 25.

"Since the first antiretroviral drug was approved 25 years ago, improvements in the potency, tolerability, simplicity, and availability of ART have resulted in dramatically reduced numbers of opportunistic diseases and deaths where ART is available," she said.

Dr. Thompson and colleagues reviewed the literature on treatment outcomes over the past 2 years to assess treatment guidelines.

Foremost, she said, is that ART treatment is recommended for all adults infected with HIV. The investigators found "no CD4 cell count threshold at which starting therapy is contraindicated, but the strength of the recommendation and the quality of the evidence supporting initiation of therapy increase as the CD4 cell count decreases and when certain concurrent conditions are present."

As the authors write in their recommendations, "The aim of therapy continues to be maximal, lifelong, and continuous suppression of HIV replication to prevent emergence of resistance, facilitate optimal immune recovery, and improve health."

"HIV monitoring should be part of a routine examination, but it needs to be individualized," Dr. Thompson told Medscape Medical News. "It is part of what we do."

Adherence to treatment is a problem, "and is something we need to do," she added. Tracking and monitoring patients is now becoming an issue, because many patients drop out of treatment and are lost to follow-up.

Treatment should begin even in the presence of opportunistic infections, Dr. Thompson asserted. "In earlier days, we thought it was better to delay ART until opportunistic infections were under control. Now we know that is not a good idea.

"We realize these guidelines are aspirational, and should guide treatment" going forward, she acknowledged. "This is going to be a problem for insurance companies...but I reject the idea that there is not enough money. We have to prioritize. This is the right thing to do. This meeting is about advocacy and doing the right thing," Dr. Thompson declared.

The guidelines were supported by the IAS-USA. Dr. Thompson and colleagues have disclosed various conflicts of interest. A full list is available on the JAMA Web site .

AIDS 2012: XIX International AIDS Conference.Presented at a press briefing July 22, 2012.

Fonte: https://www.medscape.com