"New" HIV Treatment Guidelines
I just realized that, in the madness of my October schedule, I was remiss in posting the link to the newest HIV treatment guidelines for adults. These updated guidelines were issued on October 6, 2005. The last update was on April 7, 2005. Although there were a few notable changes in the new guidelines from the older ones, overall not much has been changed with respect to the content in the guidelines. Rather, the context of certain information has been altered to make these more prevalent within the guidelines (since it is over 100 pages in length).
The biggest change (in my opinion) was the streamlining of treatment goals for patients with virologic failure (see below) and limited, intermediate, and extensive prior drug treatment and resistance. Prior to this update, the treatment goal for those with limited or intermediate prior treatment and resistance was re-suppression of the viral load and prevention of further mutation; whereas, the treatment goal for those with extensive prior treatment and resistance was preservation of immunologic function and prevention of clinical progression. In the new update, the primary treatment goal for all treatment-experienced patients with virologic failure and resistance is re-suppression of viral load. This shift in paradigm is a result of newer combinations and agents, specifically Fuzeon (enfuvirtide), that have better capability of suppressing viral load, regardless of extent of treatment experience and resistance. Newer studies have shown that, even if standard virologic suppression goals cannot be maintained, suppression to fewer than 10,000-20,000 copies/mL may increase immunologic and clinical outcomes.
Virologic failure is still defined as any one of the following:
viral load > 400 copies/mL after 24 weeks of starting/changing treatment viral load > 50 copies/mL after 48 weeks of starting/changing treatment repeated viral load > 400 copies/mL after an initial suppression to < 400 copies/mL
Page 96 (Table 30) of the updated guidelines has information for an investigational protease inhbitor (PI) now available through expanded access for patients who have failed non-nucleoside reverse transcriptase inhibitor (NNRTI)-based and two PI-based regimens and limited treatment options based on resistance patterns.
The guidelines are available at:
http://aidsinfo.nih.gov/guidelines/adult/AA_100605.pdf
As a side note, for those currently using Fuzeon or are contemplating its use and have an aversion to needles, ask your physician about the Biojector needleless system. Although not painless, the Biojector system does do away with the need for needles. More information is available at:
http://www.bioject.com/products/bio2000.html
-rxdoc
The biggest change (in my opinion) was the streamlining of treatment goals for patients with virologic failure (see below) and limited, intermediate, and extensive prior drug treatment and resistance. Prior to this update, the treatment goal for those with limited or intermediate prior treatment and resistance was re-suppression of the viral load and prevention of further mutation; whereas, the treatment goal for those with extensive prior treatment and resistance was preservation of immunologic function and prevention of clinical progression. In the new update, the primary treatment goal for all treatment-experienced patients with virologic failure and resistance is re-suppression of viral load. This shift in paradigm is a result of newer combinations and agents, specifically Fuzeon (enfuvirtide), that have better capability of suppressing viral load, regardless of extent of treatment experience and resistance. Newer studies have shown that, even if standard virologic suppression goals cannot be maintained, suppression to fewer than 10,000-20,000 copies/mL may increase immunologic and clinical outcomes.
Virologic failure is still defined as any one of the following:
Page 96 (Table 30) of the updated guidelines has information for an investigational protease inhbitor (PI) now available through expanded access for patients who have failed non-nucleoside reverse transcriptase inhibitor (NNRTI)-based and two PI-based regimens and limited treatment options based on resistance patterns.
The guidelines are available at:
http://aidsinfo.nih.gov/guidelines/adult/AA_100605.pdf
As a side note, for those currently using Fuzeon or are contemplating its use and have an aversion to needles, ask your physician about the Biojector needleless system. Although not painless, the Biojector system does do away with the need for needles. More information is available at:
http://www.bioject.com/products/bio2000.html
-rxdoc