Page 3 - HIV/AIDS Guidelines

What’s New in the Guidelines? (Last updated March 27, 2012; last reviewed
March 27, 2012)

Revisions to the October 14, 2011, version of the guidelines include both new sections and key updates to
existing sections. The additions and updates, which are highlighted throughout the guidelines, are
summarized below.

New Sections

The following two new sections have been added to the guidelines.
HIV and the Older Patient

Effective antiretroviral therapy (ART) has led to greater longevity in HIV-infected individuals resulting in an
increasing number of older individuals living with HIV infection. Compared with younger HIV-infected
patients, older patients may have more comorbidities, which can complicate treatments of HIV and other
diseases. This section focuses on HIV diagnosis and treatment considerations in the older HIV-infected patient.

Antiretroviral Drug Cost Table (Appendix C)

This new table lists the monthly average wholesale price (AWP) for U.S. Food and Drug Administration
(FDA)-approved brand and generic antiretroviral (ARV) drugs, including fixed-dose combination products.
(The AWP listed for an ARV may not represent the pharmacy acquisition price or the price paid by
consumers for that drug.)

Key Updates to Existing Sections

Following are key updates to existing sections of the guidelines.
Initiating Antiretroviral Therapy in Treatment-Naive Patients

The Panel updated its recommendations on initiation of ART in treatment-naive patients. The changes are
primarily based on increasing evidence showing the harmful impact of ongoing HIV replication on AIDS and
non-AIDS disease progression. In addition, the updated recommendations reflect emerging data showing the
benefit of effective ART in preventing secondary transmission of HIV. The updated section includes more in-
depth discussion on the rationale for these recommendations and on the risks and benefits of long-term ART.

The Panel’s recommendations are listed below.

• ART is recommended for all HIV-infected individuals. The strength of this recommendation varies on
a
the basis of pretreatment CD4 cell count:
• CD4 count <350 cells/mm (AI)
3
• CD4 count 350 to 500 cells/mm (AII)
3
3
• CD4 count >500 cells/mm (BIII)
• Regardless of CD4 count, initiation of ART is strongly recommended for individuals with the following
conditions:
• Pregnancy (AI) (see perinatal guidelines for more detailed discussion)
• History of an AIDS-defining illness (AI)

• HIV-associated nephropathy (HIVAN) (AII)
• HIV/hepatitis B virus (HBV) coinfection (AII)

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents i

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