Important note: Information in this article was accurate in 2001. The state of the art may have changed since the publication date.
Information Bulletin #13 May June 2001
Since 1997, regularly updated guidelines on how to use anti-HIV drugs have been available in the US. These guidelines are produced by a panel of experts brought together by the US Public Health Service (PHS) and the Henry J. Kaiser Family Foundation. One of the most difficult questions this panel has to consider is: when should anti-HIV drugs be started? The guidelines only make one definite recommendation. If someone has symptoms of immune dysfunction (like the fungal infection thrush, for example) or an AIDS diagnosis, anti-HIV treatment is recommended.
For people that have not yet developed symptoms, the question of when to start treatment is more complicated. A few years ago, some doctors thought that just about all HIV-positive people should be taking anti-HIV drugs. Now that it's known that HIV drugs can cause side effects which only show up after long-term treatment, people are becoming more cautious. Up until recently, the PHS guidelines have said that anyone with a viral load over 20,000 or a T-cell count less than 500 should be "offered" treatment.
The guidelines also noted that some experts would wait until the T-cell count is under 350, and evidence of HIV disease progression is seen before starting treatment. The new PHS guidelines, however, recommend starting treatment if the T-cell count falls below 350 or if the viral load increases to over 55,000 copies (using the more commonly used Amplicor PCR viral load test - the equivalent number on the bDNA viral load test would be 30,000 copies).
Several new treatments are also included among those recommended as first line therapy, including the combination of Crixivan and Norvir, Fortovase and Norvir, and the newly approved protease inhibitor Kaletra (which is lopinavir and norvir).
In addition, the Perinatal HIV Guidelines Working Group has developed revised guidelines for the clinical use of antiretroviral agents in the treatment of pregnant women. These guidelines are available at http://hivatis.org/request.html/list
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