Author Affiliations: Department of Infectious Diseases, Hôpital Bichat-Claude Bernard, X. Bichat Medical School, Paris, France (Dr Yeni); Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY (Dr Hammer); Department of Immunology and Infectious Diseases, Harvard Medical School, Boston, Mass (Dr Hirsch); Department of Medicine, University of Alabama, Birmingham (Dr Saag); Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil (Dr Schechter); Department of Biomedicine, Brown University School of Medicine, Providence, RI (Dr Carpenter); Department of Medicine, University of Miami School of Medicine, Miami, Fla (Dr Fischl); Department of Medicine, University of Barcelona, Barcelona, Spain (Dr Gatell); Department of HIV Medicine, Chelsea and Westminster Hospital, London, England (Dr Gazzard); International AIDS Society-USA, San Francisco, Calif (Ms Jacobsen); Department of Medicine, Stanford University Medical Center, Stanford, Calif (Dr Katzenstein); Department of Medicine, University of British Columbia, Vancouver (Dr Montaner); Departments of Pathology and Medicine, University of California and San Diego VA Healthcare System, San Diego (Dr Richman); Department of Medicine, University of Colorado School of Medicine, Denver (Dr Schooley); AIDS Research Consortium of Atlanta, Ga (Dr Thompson); Istituto Superiore di Sanità, Rome, Italy (Dr Vella); Department of Medicine, University of California and San Francisco Veterans Affairs Medical Center, San Francisco (Dr Volberding).
Context Substantial changes in the field of human immunodeficiency virus (HIV)
treatment have occurred in the last 2 years, prompting revision of the guidelines
for antiretroviral management of adults with established HIV infection.
Objective To update recommendations for physicians who provide HIV care regarding
when to start antiretroviral therapy, what drugs to start with, when to change
drug regimens, and what drug regimens to switch to after therapy fails.
Data Sources Evidence was identified and reviewed by a 16-member noncompensated panel
of physicians with expertise in HIV-related basic science and clinical research,
antiretroviral therapy, and HIV patient care. The panel was designed to have
broad US and international representation for areas with adequate access to
Study Selection Evidence considered included published basic science, clinical research,
and epidemiological data (identified by experts in the field or extracted
through MEDLINE searches using terms relevant to antiretroviral therapy) and
abstracts from HIV-oriented scientific conferences between July 2002 and May
Data Extraction Data were reviewed to identify any information that might change previous
guidelines. Based on panel discussion, guidelines were drafted by a writing
committee and discussed by the panel until consensus was reached.
Data Synthesis Four antiretroviral drugs recently have been made available and have
broadened the options for initial and subsequent regimens. New data allow
more definitive recommendations for specific drugs or regimens to include
or avoid, particularly with regard to initial therapy. Recommendations are
rated according to 7 evidence categories, ranging from I (data from prospective
randomized clinical trials) to VII (expert opinion of the panel).
Conclusion Further insights into the roles of drug toxic effects, drug resistance,
and pharmacological interactions have resulted in additional guidance for
strategic approaches to antiretroviral management.
Yeni PG, Hammer SM, Hirsch MS, Saag MS, Schechter M, Carpenter CCJ, Fischl MA, Gatell JM, Gazzard BG, Jacobsen DM, Katzenstein DA, Montaner JSG, Richman DD, Schooley RT, Thompson MA, Vella S, Volberding PA. Treatment for Adult HIV Infection2004 Recommendations of the International AIDS Society-USA Panel. JAMA. 2004;292(2):251-265. doi:10.1001/jama.292.2.251