March 2001 • Volume 7 • Number 3
HIV treatment guidelines updated
HIV infection has affected the lives of hundreds of thousands of Americans in the past two decades and millions of people worldwide. Although it's far from being a "gay disease," as it was once characterized, members of the gay, lesbian, bisexual and transgender community have an immense stake in new insights into dealing with this health scourge.
New federal guidelines recommending a delay in beginning HIV treatment in asymptomatic individuals were announced at the Eighth Annual Retrovirus Conference in Chicago last month. The guidelines fly in the face of the previous "hit early, hit hard" strategy in effect since widespread use of anti-HIV "drug cocktails" began in the mid-1990s.
In short, the Panel on Clinical Practices for the Treatment of HIV Infection recommends waiting to begin treatment until the body's supply of CD4 cells drops to 350 per milliliter of blood or until the viral load exceeds 30,000 copies per ml as measured by the branched DNA test (55,000 per ml as measured by the polymerase chain reaction test). The panel is a collaborative effort of HHS and the Henry J. Kaiser Family Foundation.
Recent studies suggest that while highly active antiretroviral therapies can knock the amount of HIV in the blood back to undetectable levels, the therapies fail to eradicate the disease as once hoped. Thus, patients must continue on lifelong treatment.
Therein, say HIV researchers, lies the problem. These highly potent drugs carry hefty side effects over the long term, including anomalies in body fat distribution and fat metabolism as well as osteonecrotic changes, particularly in the hip. One major concern is spawning an epidemic of coronary disease in HIV-infected patients using these treatments; these drugs can precipitate startling elevations in cholesterol and triglycerides.
The guidelines include new drug-specific recommendations. Go to http://www.hivatis.org to view them. Single copies can be ordered by calling (800) 448-0440.
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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