Panel Urges Expanded Use of Antiretrovirals for HIV

Dr. Liza A. McClellan reports:

An international panel of experts recommended Sunday that antiretroviral therapy start earlier for patients infected with the human immunodeficiency virus (HIV).

The new recommendations, released at the 19th International AIDS Conference in Washington, D.C., illustrate a new era in the treatment of HIV, one in which physicians are not only concerned about AIDS' defining illnesses, but also the damage that the virus can cause when it is not controlled.

Traditionally, patients do not start therapy until levels of a specific kind of immune cell in the body - the CD4 cells - drop below 500. But multiple studies in the past two years suggest that therapy is beneficial to patients at any CD4 count.

The nonprofit group International Antiviral Society-USA pointed out new evidence that suggests that the untreated virus can lead to other conditions, such as kidney disease and cardiovascular disease.

"We are no longer only focused on traditional AIDS-defining infections," said Dr. Melanie Thompson, principal investigator of the AIDS Research Consortium of Atlanta and a member of the Antiviral Society. "We know that HIV is doing damage to the body all the time."

The panelists stated that the new antiretroviral medications are friendlier and have fewer side effects, which has played a role in their decision to suggest starting these medications earlier. Previous guidelines were influenced by earlier antiretroviral drugs, which had many more side effects and complications. The recommendations, although global, are aimed in particular toward countries that have the resources to provide treatment to everyone who needs it.

The new recommendations, if adopted, will lead to many of patients not previously on therapy taking medications, which some warn might lead to increased resistance to existing antiretroviral therapies.

The U.S. Food and Drug Administration last week approved the use of Truvada, a combination of two antiretroviral drugs, for pre-exposure prophylaxis (PrEP); in other words, in people who are not yet infected but who are at high risk of contracting the virus.

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