Page 4 - HIV/AIDS Guidelines

• Effective ART also has been shown to prevent transmission of HIV from an infected individual to a
sexual partner. Therefore, ART should be offered to patients who are at risk of transmitting HIV to sexual
partners (AI [heterosexuals] or AIII [other transmission risk groups]).
• Patients starting ART should be willing and able to commit to treatment and should understand the
benefits and risks of therapy and the importance of adherence (AIII). Patients may choose to postpone
therapy, and providers, on a case-by-case basis, may elect to defer therapy on the basis of clinical and/or
psychosocial factors.

HIV-Infected Women

This revised section includes an expanded discussion on the use of hormonal contraception in HIV-infected
women. The discussion focuses on drug-drug interactions between combined oral contraceptives and ARV
drugs as well as on recent data showing a possible association between hormonal contraceptive use and
acquisition or transmission of HIV.
HIV/Hepatitis C Coinfection

Updates to this section focus on the newly approved HCV NS3/4A protease inhibitors (PIs) boceprevir and
telaprevir, the known interactions between these drugs and ART, and interim results from current ongoing
research in HIV/HCV coinfected patients. The updated section includes preliminary recommendations on
coadministration of the HCV NS3/4A drugs and ART.
Mycobacterium tuberculosis Disease with HIV Coinfection

This update provides recommendations for timing of initiation of ART in HIV-infected patients who have
been diagnosed with tuberculosis (TB) and are not receiving ART. The recommendations are based on results
from randomized controlled trials showing survival benefits (1) when ART was initiated during rather than
after TB treatment and (2) when ART was started within 2 weeks of TB treatment in patients with
pretreatment CD4 count <50 cells/mm . The updated section provides more in-depth discussions on the
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evidence and rationale supporting the recommendations.
The Panel’s recommendations are as follows:

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• For patients with CD4 counts <50 cells/mm , ART should be initiated within 2 weeks of starting TB
treatment (AI).
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• For patients with CD4 counts ≥50 cells/mm with clinical disease of major severity as indicated by
clinical evaluation (including low Karnofsky score, low body mass index [BMI], low hemoglobin, low
albumin, organ system dysfunction, or extent of disease), the Panel recommends initiation of ART within
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2 to 4 weeks of starting TB treatment (BI for CD4 count 50–200 cells/mm and BIII for CD4 count >200
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cells/mm ).
• For other patients with CD4 counts ≥50 cells/mm , ART can be delayed beyond 2 to 4 weeks but should
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be initiated by 8 to 12 weeks of TB therapy (AI for CD4 count 50–500 cells/mm ; BIII for CD4 count
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>500 cells/mm ).
Drug Interaction Tables (Tables 14-16b)
These tables are updated with recent data on pharmacokinetic (PK) interactions between ARV drugs and
other drugs commonly prescribed for HIV-infected patients and the Panel’s recommendations on
coadministration of these drugs. The key updates include:

• Change in recommendation on dosing of rifabutin with HIV PIs

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

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