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August 27, 1997

Debating Dual AIDS Guidelines

JAMA. 1997;278(8):613-614. doi:10.1001/jama.1997.03550080019009

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PHYSICIANS SEEKING guidance on combination therapy for their HIVinfected patients may have felt a sense of déjà vu late last June.

New guidelines from the US Department of Health and Human Services (DHHS) and the Henry J. Kaiser Family Foundation appeared for public comment June 19 in the Federal Register. Six days later, the American Medical Association (AMA) published an update of year-old recommendations from the International AIDS Society—USA (IAS-USA) (JAMA. 1997;277:1962-1969).

Both recommend using a 3-drug combination that includes a protease inhibitor in the initial regimen. Both say that monotherapy constitutes substandard care. Both point out that if asymptomatic patients at low risk of disease progression can't comply with complex regimens, treatment probably should be delayed instead of risking the development of drug resistance.

One of the few discrepancies surrounds the issue of when to start treatment. The IAS-USA update is more aggressive, recommending treatment when plasma HIV RNA

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