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7/29/2003

HHS Updates HIV Treatment Guidelines

Kate Traynor

The Department of Health and Human Services has released a new version of its Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents.

This revision, the eighth since the document was first released in 1998, contains extensive information about drug therapy regimens for patients infected with HIV-1.

"These revised Guidelines help simplify the process by which caregivers and patients chart a course of therapy, whether they are receiving antiretroviral treatment for the first time or are treatment-experienced and contemplating a change in drug regimen," said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, in a July 14 press release.

New to the guidelines is a section in which tables describe preferred and alternative drug regimens and explain the benefits and drawbacks of each drug. Another addition is a table listing drugs and treatment regimens that should be avoided in certain patients, such as pregnant women, and therapeutic regimens that no patient should be offered.

Sections dealing with adherence to therapy urge health care providers to anticipate the occurrence of adverse events and treat them when they arise. The guidelines mention the use of symptomatic treatment, such as antidiarrheal or antiemetic drugs, to relieve the discomforts associated with antiretroviral therapy. Another recommended tactic is to switch to a different antiretroviral drug in the same class as the problematic drug, or to use a different class of drug that is not likely to cause the troublesome symptoms.

The guidelines emphasize other strategies designed to improve the patient's quality of life—for example, reducing the daily "pill burden," decreasing the overall dosing frequency, and considering how the therapeutic regimen affects a patient's mealtimes.

A new section in the guidelines addresses drug-drug interactions and recommends that the potential for such interactions be examined any time a patient's therapy is changed. The guidelines note that commonly prescribed medications, such as lipid-lowering agents, benzodiazepines, and sildenafil, can have "significant interactions" with protease inhibitors and nonnucleoside reverse-transcriptase inhibitors.

The guidelines contain limited information about the use of enfuvirtide, the HIV-1 fusion inhibitor recently marketed as Fuzeon by Roche Laboratories Inc. and Trimeris Inc. Bristol-Myers Squibb Co.'s atazanavir sulfate product, Reyataz, is not described in the guidelines but will be included in the next revision, according to the document's authors.