Context Substantial changes in the field of human immunodeficiency virus (HIV)
treatment have occurred in the last 2 years, prompting revision of the guidelines
for antiretroviral management of adults with established HIV infection.
Objective To update recommendations for physicians who provide HIV care regarding
when to start antiretroviral therapy, what drugs to start with, when to change
drug regimens, and what drug regimens to switch to after therapy fails.
Data Sources Evidence was identified and reviewed by a 16-member noncompensated panel
of physicians with expertise in HIV-related basic science and clinical research,
antiretroviral therapy, and HIV patient care. The panel was designed to have
broad US and international representation for areas with adequate access to
Study Selection Evidence considered included published basic science, clinical research,
and epidemiological data (identified by experts in the field or extracted
through MEDLINE searches using terms relevant to antiretroviral therapy) and
abstracts from HIV-oriented scientific conferences between July 2002 and May
Data Extraction Data were reviewed to identify any information that might change previous
guidelines. Based on panel discussion, guidelines were drafted by a writing
committee and discussed by the panel until consensus was reached.
Data Synthesis Four antiretroviral drugs recently have been made available and have
broadened the options for initial and subsequent regimens. New data allow
more definitive recommendations for specific drugs or regimens to include
or avoid, particularly with regard to initial therapy. Recommendations are
rated according to 7 evidence categories, ranging from I (data from prospective
randomized clinical trials) to VII (expert opinion of the panel).
Conclusion Further insights into the roles of drug toxic effects, drug resistance,
and pharmacological interactions have resulted in additional guidance for
strategic approaches to antiretroviral management.