Small but important revisions to the U.S. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents (PDF) were published in a revised document on November 10, 2003. The latest HIV treatment guidelines are always available at: www.aidsinfo.nih.gov/guidelines/.

The revised guidelines include warnings against two three-drug NRTI combinations that should never be used as a triple regimen (abacavir + tenofovir + lamivudine, and tenofovir + didanosine + lamivudine), because these regimens failed to control viral load in treatment-naive volunteers in recent clinical trials, leading to development of viral resistance in some patients. The problem with these regimens is well known -- but unless the warning is in the guidelines, some physicians with little HIV experience may make a mistake.

The warning against combining d4T + ddI (stavudine plus didanosine) due to risk of toxicities now clearly applies not only in pregnancy but to anyone (unless the benefits outweigh the risks for a particular patient). The previous edition of the guidelines had been criticized for being ambiguous on this.

The revised guidelines warn against combining atazanavir + indinavir (possible worse hyperbilirubinemia), and FTC + 3TC (similar resistance profile, without additional benefit).

And they also include additional information on T-20 (enfuvirtide).

Atazanavir and FTC have been added to the guidelines as potential alternative drugs in certain regimens. (The new guidelines also make it clear that "alternative" recommendations can be the preferred treatment for some patients.)

This edition includes a helpful "What's New in This Document?" section just after the cover page.

Patients who want to check to see how their treatment compares should note that much of the information is in the tables at the end of the document. Remember that HIV-expert physicians may have good reason for not following the guidelines in some cases.

Pediatric HIV Guidelines Revised

A revised Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection was published November 26, 2003, by the U.S. Department of Health and Human Services. It is also available at the U.S. government Web site for official HIV treatment and related guidelines: www.aidsinfo.nih.gov/guidelines/.

ISSN # 1052-4207

Copyright 2003 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used.

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This article was provided by AIDS Treatment News, and is a part of the publication AIDS Treatment News.