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New HIV/AIDS Guidelines Suggest Earlier Treatment

Posted on 08/03/2008, 12:00
By Amanda Gardner, HealthDay Reporter

Goal is to reduce number of pills and dosage content, researchers say

SUNDAY, Aug. 3 (HealthDay News) -- New guidelines for treating HIV and AIDS patients with treatments known as antiretrovirals suggest earlier therapy might be effective.

The findings were slated to be presented at the International AIDS Conference in Mexico City Sunday. They will also appear in the Aug. 6 issue of the Journal of the American Medical Association (JAMA).

The new guidelines were written by the International AIDS Society-USA Panel, and recommend starting therapy before immune-system CD4 cell counts decline to less than 350 cells per microliter. Additional factors should be considered when starting therapy at higher CD4 levels.

"As we now have developed treatments that are easier to take in terms of number of pills, number of doses in the day and potential adverse effects, and we now know there seem to be additional benefits with starting earlier, the pendulum is swinging back to starting [treatment] earlier," noted Dr. Michael Horberg, director of HIV/AIDS policy at Kaiser Permanente Health Plan in Santa Clara, Calif. "Also, importantly, is the recognition of comorbidities that should prompt you to start treatment earlier, including hepatitis B or C, cardiovascular risk, and HIV-associated necropathy."

The authors of the guidelines also recommended that frontline regimens be individualized, and that certain drugs such as Sustiva (efavirenz) be given high consideration.

Patient plasma HIV-1 RNA levels should be monitored regularly, and genotypic testing for drug resistance also should be performed for certain patients.

The guidelines also addressed changing therapies and when to introduce new drugs.

In other news from the AIDS conference:

• Patients taking rifampicin-based therapy for tuberculosis were more likely to experience virological failure (failure to keep viral levels low) when they start nevirapine-based antiretroviral therapy as opposed to efavirenz-based antiretroviral therapy. Nevirapine-based therapy costs less and is used more often in developing areas of the world.
• HIV-infected patients with abdominal obesity and growth hormone deficiency related to their treatment regimens who received low-dose growth hormone showed improvements in fat and blood pressure measurements but worse glucose levels.
• The survival rate between HIV-infected intravenous drug users and non-drug users appears similar after four to five years of active antiretroviral therapy. This is in contrast to previous reports.

"The take-home message is 'prevention is always better than treatment,' which seems to be possible through the utilization of the latest diagnostic techniques," said Srikanth Kolluru, an assistant professor of pharmaceutical sciences at Texas A&M Health Science Center Irma Lerma Rangel College of Pharmacy in Kingsville.

More information

There's much more on HIV/AIDS at the U.S. government's AIDS.gov Web site.

SOURCES: Michael Horberg, M.D., director, HIV/AIDS policy, Kaiser Permanente Health Plan, Santa Clara, Calif.; Srikanth Kolluru, Ph.D., assistant professor, pharmaceutical sciences, Texas A&M Health Science Center Irma Lerma Rangel College of Pharmacy, Kingsville; Aug. 6, 2008, Journal of the American Medical Association

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