Clinical Education Center
Current Issues and Hot Topics in HIV Treatment & Diagnostics
In January 2011, the U.S. Department of Health and Services (DHHS) published revised “Guidelines for the Use of Antiretroviral Agents in HIV-infected Adults and Adolescents.” They offer a number of updates on important issues, including:
- Recommending early initiation of antiretroviral therapy (ART) at CD4(+) counts of 350-500 cells/uL. (This recommendation was first introduced in the December 2009 guidelines.)
- Expanding the list of recommended initial ART regimens to include newly introduced drugs, such as the entry inhibitor maraviroc or the integrase inhibitor raltegravir, which may be used in combination with some dual-nucleoside RT inhibitor backbones. (Other combinations for regiment simplification are discussed in the DHHS treatment guidelines as well.)
- Defining virologic failure as a confirmed viral above 200 copies/mL to eliminate isolated viral “blips” as virologic failure-defining events. As increasingly sensitive viral load tests become available, it will be important to distinguish between isolated events (i.e., “blips”) and actual virologic failures.
- As the use of integrase inhibitors (INSTIs) increases, recommending genotype testing for resistance to INSTIs as an option for treatment-naïve patients and for patients failing integrase inhibitor regimens.
Recent European Consensus Panel Guidelines endorsed genotypic tropism testing as a viable alternative to phenotype tropism testing. The current DHHS treatment guidelines do not yet endorse the European approach and recommend phenotypic tropism testing when available. The field of tropism testing continues to evolve and should remain a hot topic for the near future.
Authors contributing to Expert Insights: