On May 1, 2014, the revised Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents was made available. Additionally the Guidelines for the Use of Antiretroviral Agents in Pediatric HIV infection were revised in February 2014 and the Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1 Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States were released in March 2014 What's New in the Adult and Adolescent Antiretroviral Treatment Guidelines?Revisions to the February 12, 2013, version of the guidelines include both a new section and key updates to existing sections. Significant updates are highlighted throughout the PDF version of the document. New Section Cost Considerations and Antiretroviral Therapy
Key Updates to Existing Sections The following are key updates to existing sections of the guidelines. Change in Recommendations on Frequency of CD4 Count Monitoring This change can be found in the “Laboratory Testing: HIV-RNA (Viral Load) and CD4 Count Monitoring” section.
Change in Classification of Recommendations for Initial Treatment From “Preferred Regimens” to “Recommended Regimens” This change can be found in the “What to Start: Initial Combination Regimens for the Antiretroviral-Naive Patient” section.
1. Regimens for ART-naive patients regardless of baseline viral load or CD4 cell count. These regimens include those previously termed “Preferred,” namely tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) with either efavirenz (EFV); ritonavir-boosted atazanavir (ATV/r) or darunavir (DRV/r); or raltegravir (RAL). In addition, 3 new regimens have been added to this category:
2. Regimens that are also recommended, but only for patients with pre-ART plasma HIV RNA <100,000 copies/mL. These regimens include the following:
Emphasis on Key Principles to Follow When Switching ARV Drugs in the Setting of Viral Suppression The “Regimen Simplification” section of the previous guideline has been updated with a new title—“Regimen Switching in the Setting of Viral Suppression”—and includes the following key revisions.
Addition of a New Table That Provides Recommendations on ARV Drug Options When Switching ARV Drugs Because of Adverse Effects
Additional Updates Minor revisions have also been made to the following sections:
The most up-to-date versions of all the Clinical Guidelines can always be found at the Clinical Guidelines Portal, at the AIDSinfo web site.
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