Objective.— To provide recommendations for antiretroviral therapy based on information
available in mid-1998.
Participants.— An international panel of physicians with expertise in antiretroviral
research and care of patients with human immunodeficiency virus (HIV) infection,
first convened by the International AIDS Society–USA in December 1995.
Evidence. —The panel reviewed available clinical and basic science study
results (including phase 3 controlled trials; clinical, virologic, and immunologic
end point data; data presented at research conferences; and studies of HIV
pathophysiology); opinions of panel members were also considered. Recommendations
were limited to drugs available in mid-1998.
Consensus Process. —Panel members monitor new clinical research reports and interim
results. The full panel meets regularly to discuss how the new information
may change treatment recommendations. Updated recommendations are developed
through consensus of the entire panel at each stage of development.
Conclusions. —Accumulating data from clinical and pathogenesis studies continue
to support early institution of potent antiretroviral therapy in patients
with HIV infection. A variety of combination regimens show potency, expanding
choices for initial regimens for individual patients. Plasma HIV RNA assays
with increased sensitivity are important in monitoring therapeutic response;
however, more data are needed to determine precisely the HIV RNA levels that
define treatment failure. Long-term adverse drug effects are beginning to
emerge, requiring ongoing attention. Some issues regarding optimal long-term
approaches to antiretroviral management are unresolved. The increased complexity
in HIV management requires ongoing monitoring of new data for optimal treatment
of HIV infection.