New Guidelines for Antiretroviral Therapy for HIV Infection

New Guidelines for Antiretroviral Therapy for HIV Infection

Seattle Treatment Education Project (STEP) Perspective, Vol. 5, No. 2 - July 1993 * 127 Broadway E. Ste 200 Seattle, WA 98102
Joel Gibson, MS

The National Institue of Allergy and Infectious Diseases (NIAID) recently called together a panel of experts to ammend current recommendations on the use of antiretroviral therapy in HIV infection. Prior to this meeting, the most recent recommendations had been approved in 1990. The panel of experts were not involved in any of the efficacy trials which were put before them to be used to evaluate what the new recommendations might me. The panel met on June 23-25 and issued preliminary guidelines on June 25. Final recommendations will be submitted the end of July for publication. The panel's recommendations are not federal or NIAID policy. Rather they are to help guide health care providers who are caring for HIV infected adults during all stages of HIV disease. In writing the recommendations, the panel emphasized the choice to accept or decline antiretroviral therapy ultimately rests with the patient. Further, "early intervention" does not necessarily mean giving drugs to stable, asymptomatic individuals, but also involves primary medical care, including management of the patient's overall health status, and providing emotional and psychological support.

For individuals who have never received antiretroviral therapy:

For asymptomatics with CD4 counts of >500, monitoring of CD4 counts every 6 months.

For asymptomatics with CD4 counts of 200-500 and who are clinically stable, either of the following options are OK:

Initiation of antiretroviral therapy;

Continued observation and monitoring for clinical or laboratory evidence of deterioration, at which point antiretroviral therapy should be initiated.

For persons with 200-500 CD4 cells who have experienced symptomatic HIV disease, initiate antiretroviral therapy.

When choosing an initial antiretroviral therapy:

Use AZT as the first-line therapy in patients who have received no prior antiretroviral therapy. The recommended dose is 600 mg/day in divided doses. This is true whether the individual is asymptomatic or not and regardless of CD4 level.

Combination therapy with AZT & ddI or AZT & ddC also may be considered, although clinical trials have not conclusively demonstrated clinical benefit to date.

With regard to change of antiretroviral therapy in individuals who are tolerating AZT:

If individual has >300 CD4 cells and is stable, continue initial AZT therapy;

For those with <300 CD4 cells, there are 2 options:

Continue AZT;

Change to ddI. The strongest data supporting a change to ddI was seen after at least 4 months of initial AZT therapy.

For individuals who are intolerant to AZT or who experience progression of disease despite AZT therapy:

In those with CD4 counts between 50 and 500 who are intolerant to AZT, switch to ddI monotherapy.

Individuals with <50 CD4 cells who are intolerant to AZT could switch to ddI or ddC monotherapy. Another option includes discontinuing antiretroviral therapy.

For those with CD4 counts between 50 and 500 who show signs of clinical progression, options include switching to ddI monotherapy, or adding a second agent, either ddI or ddC.

For those with <50 CD4 cells who have evidence of disease progression, the panel recommends switching to an alternative monotherapy, either ddI or ddC. Combination therapy is another option.

For individuals with >500 CD4 cells who are taking AZT but experience intolerance, the panel recommends discontinuation of therapy.
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Always watch for outdated information. This article first appeard in 1993. This material is designed to support, not replace, the relationship that exists between you and your doctor.

Copyright © 1993 - Seattle Treatment Education Project (STEP) - All rights reserved. Noncommercial reproduction is encouraged. STEP is published four times a year by the Seattle Treatment Education Project, 127 Broadway East, 3rd Floor, Seattle, WA 98102. Email: step100@aol.com STEP web page

This information is designed to support, not replace, the relationship that exists between you and your doctor.
©1993. AEGIS.