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DHHS GUIDELINES FOR THE USE OF ANTIRETROVIRAL AGENTS IN PATIENTS WITH HIV-1 INFECTION —

Current treatment goals for patients with HIV are focused on reducing HIV-related morbidity, prolonging survival, improving quality of life, and preventing HIV transmission by maximally suppressing viral replication for as long as possible, while restoring or preserving immune function. To achieve these goals, clinicians must select a potent antiretroviral regimen from multiple drug classes, which preferably includes 3 active drugs against the major strains of HIV in a given patient. This article explores current treatment recommendations for treatment-naïve and treatment-experienced patients, from the Department of Health and Human Services’ Antiretroviral Guidelines for Adults and Adolescents. Also included are antiretroviral agents and combinations of agents that are not recommended due to lack of potency or safety concerns. For treatmentnaïve patients, current “preferred” antiretroviral regimens consist of 2 nucleoside reverse transcriptase inhibitors (NRTIs), combined with either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a ritonavir-boosted protease inhibitor (PI). Guideline-preferred antiretroviral agents for initial therapy include the NNRTI efavirenz; the PI-based regimens atazanavir + ritonavir, fosamprenavir + ritonavir, and lopinavir/ritonavir (coformulated); and the NRTIs abacavir/lamivudine (coformulated) and tenofovir/emtricitabine (coformulated). For treatment-experienced patients, strategies involved in managing virologic and immunologic failures, in addition to clinical progression, are discussed. (Adv Stud Pharm. 2008;5(4):97-104)