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6/19/2002

CDC Guidelines Address Treatment of HIV, STD Infections

Kate Traynor

Guidelines released in May by the Centers for Disease Control and Prevention (CDC) provide the agency's current recommendations for the treatment of human immunodeficiency virus (HIV) infection and other sexually transmitted diseases (STDs).

HIV. CDC's HIV treatment guidelines address the use of antiretroviral agents in symptomatic and asymptomatic adults and adolescents who are infected with the virus.1 Alice K. Pau, Pharm.D., FASHP, a clinical pharmacist at the National Institutes of Health and a coauthor of the guidelines, said the document is a great resource for pharmacists who help monitor complex antiretroviral regimens.

"Most of the patients will be taking multiple-drug therapy along with the antiretroviral agents," Pau said. "There's a lot of potential for pharmacists intervening with monitoring for drug-drug interactions, [and] side effects."

Pau described the document's many tables as a convenient source of drug information that pharmacists would otherwise have to obtain from multiple package inserts.

One set of tables describes dosage recommendations, bioavailability, and common adverse reactions for nucleoside and nucleotide reverse-transcriptase (RT) inhibitors, nonnucleoside RT inhibitors, and protease inhibitors. Other tables list important drug-drug interactions between antiretrovirals and other medications and describe how concurrent use of multiple antiretrovirals affects the way the products are metabolized.

Also included in the HIV treatment guidelines is information about promoting patients' adherence to antiretroviral therapy. The guidelines note that pharmacist-based "adherence clinics" can help keep patients' therapy on track.

STDs. CDC's new STD treatment guidelines are the fifth edition of a document originally published in 1982.2 The document includes standard and alternative drug regimens for the treatment of a wide variety of STDs.

A major recommendation in the guidelines is to use cefixime or ceftriaxone instead of fluoroquinolone antimicrobials to treat Neisseria gonorrhoeae infections in patients who contract gonorrhea in California. CDC Epidemiology and Surveillance Branch Chief Stuart Berman, during a May 9 telebriefing on the guidelines, said that the resistance of California-acquired N. gonorrhoeae to fluoroquinolones "has become unacceptably common." Previously, CDC had advised against fluoroquinolones for the treatment of gonorrhea contracted in Hawaii, the Pacific Islands, and Asia, where fluoroquinolone-resistant N. gonorrhoeae is widespread.

One section of the guidelines promotes vaccination against hepatitis A and B for people who are at particular risk for contracting the diseases. All people who seek treatment for an STD are considered candidates for hepatitis B vaccination, and injection-drug users and men who have sex with men are candidates for the hepatitis A vaccine.

New to this edition of the guidelines is the inclusion of hepatitis C virus infection as an STD. The document says little about therapy for people infected with the virus but notes instead that knowledge of the subject is rapidly advancing. Clinicians are asked to consult with a specialist in hepatitis C virus infection for specific treatment information.

  1. Centers for Disease Control and Prevention. Guidelines for using antiretroviral agents among HIV-infected adults and adolescents: recommendations of the Panel on Clinical Practices for Treatment of HIV. MMWR. 2002; 51(RR-7):1-64.
  2. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR. 2002; 51(RR-6):1-84.