Treatment of HIV: A Guide For Patients and Doctors
Posted Aug 24 2008 1:49pm
ANNOUNCER: As the management of HIV evolves, several expert groups have developed treatment guidelines to help doctors and patients stay up to date. One set has been developed by the US department of health and human services.
EDWIN DeJESUS, MD: They cover anywhere from when to start a patient on antiretroviral therapy, what to start a patient on, when to switch that patient, what to switch the patient. So it covers a wide variety of aspects that are very important in the HIV treatment.
ANNOUNCER: To develop these guidelines, the government puts together a panel of HIV experts.
BRIAN BOYLE, MD: The DHHS committee meets and they evaluate the particular data that has been accumulated for the recommendations that they're considering. So, for example, when they consider when should patients be started on therapy, they look at the studies that have been done and they look at how patients have done when they've been started on therapy. And where it appears that patients benefit the most from starting therapy.
ANNOUNCER: "When to start therapy" is one of the most important topics.
BRIAN BOYLE, MD: The guidelines recommend that patients who have symptomatic HIV disease or a CD4 count less than 200 start therapy. The guidelines also recommend that patients be considered for therapy if their CD4 count is between 200 and 350 T-cells or if their viral load is greater than 55,000 copies.
ANNOUNCER: The guidelines also make specific recommendations on what antiretroviral medicines to use and in what combinations.
BRIAN BOYLE, MD: There are two different classes of drugs under the DHHS guidelines. There are the strongly recommended drugs and there are the alternative drugs.
EDWIN DeJESUS, MD: The guidelines currently recommend the use of a non-nucleoside or a protease inhibitor in combination with two nucleosides. The non-nucleoside strongly recommended is Sustiva in combination with Epivir and AZT, Epivir and Viread or Zerit and Epivir. The protease inhibitors are Kaletra in combination with Epivir and either Zerit or AZT.
BRIAN BOYLE, MD: The alternative drugs could also be considered under certain circumstances. But the data supporting their use is not as strong as the drugs in the strongly recommended category.
ANNOUNCER: But research is constantly leading to new drugs and to new clinical practices.
EDWIN DeJESUS, MD: Unfortunately, by the time that the guideline becomes available, some new information is also available that, to some extent, may contradict some of the recommendations.
ANNOUNCER: To make sure the guidelines reflect the newest information, they are frequently reviewed.
BRIAN BOYLE, MD: The guidelines are constantly updated and they're updated because things change and things can change very rapidly. And so, at each conference, new data are presented and hopefully, over the years, new drugs are approved. And so, as that happens, the guidelines need to be revised to reflect that.