July 23rd, 2012

IAS-USA HIV Guidelines Updated

With the International AIDS Conference in Washington just starting, the International Antiviral (ahem) Society-USA has revised its HIV treatment guidelines, updating the 2010 version.

As has been the case for several years now, it’s published in JAMA and also available on the IAS-USA web site. It’s a well written, evidence-driven summary of the current state of HIV treatment, with a highly respected authorship group, headed again this time by Melanie Thompson.

It is more fully covered by Abbie Zuger on Journal Watch: AIDS Clinical Care, but some medical highlights:

  • HIV treatment recommended for all, with the possible exception of HIV controllers and long-term nonprogressors.
  • They have shifted towards listing full regimens rather than “NRTI pair + key third drug”.
  • Some abacavir/3TC-based regimens have moved into the “Recommended” category, provided the HLA-B*5701 is negative and the HIV RNA is < 100,000 cop/mL.
  • Tenofovir/FTC/elvitegravir/cobicistat (“Quad”) is listed as an alternative treatment, with an acknowledgment that this treatment is not yet approved.
  • There’s a section on PrEP with tenofovir/FTC.
  • Viral load and CD4 monitoring can be reduced to twice-yearly in clinically stable patients. (Of course you don’t need to measure CD4 at all once someone is stable on treatment — see here for an explanation.)
  • There’s a box nicely summarizing all the changes since the 2010 version.
Now for the non-medical summary:
  • The “USA” part of IAS-USA is to distinguish this from the other IAS, which is still called the International AIDS Society.
  • Abbreviation for “integrase inhibitors”?  InSTIs, which is hard to type, but not nearly as hard as iPrEx.
  • If you want to target the areas of controversy in the field that nonetheless deserve some sort of comment — timing of HIV therapy with HCV, abacavir and CVD, use of therapeutic drug monitoring, etc — simply do a search on the word “might.” Guidelines writers love that word when the data are inconclusive.
Finally, lots of the the IAS-USA content is similar to what’s in the DHHS Guidelines — I’m a panel member on that one, and some people have been/are a panel member on both. One might (there it is again) wonder why two such entities are necessary, but I for one value the slightly different perspectives.

Comments are closed.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

Biography | Disclosures | Summaries

Learn more about HIV and ID Observations.