Revised guidelines will ease selection of HIV/AIDS treatments

July 14, 2003

A new update of the U.S. Department of Health and Human Services (DHHS) Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents will make it easier for clinicians and HIV-infected individuals to select an appropriate treatment regimen from among the expanding choices of anti-HIV medications. The revised Guidelines are available on the HHS AIDSInfo Web site at:

Previous versions of the Guidelines grouped commonly used antiretroviral agents into columns and asked clinicians to construct a combination regimen by adding drugs from one column with those from another. As the number of available antiretroviral medications has increased, constructing an effective regimen based on this "menu" format has become increasingly difficult.

The new Guidelines provide practitioners with a list of suggested combination regimens for the initiation of antiretroviral therapy. Based on results of clinical trials and expert opinion, the suggested regimens are classified as either "preferred" or "alternative." "With 22 FDA-approved formulations of antiretroviral agents, selecting the right multi-drug combination can be a challenge for even experienced clinicians," explains Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID). "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."

Dr. Fauci and John G. Bartlett, M.D., chief of the Division of Infectious Diseases at the Johns Hopkins University Medical Center, co-chair the Panel on Clinical Practices for the Treatment of HIV Infection, convened by DHHS. The Panel updates the Guidelines as new data emerge. First published in 1998, the Guidelines have been revised eight times to keep pace with discoveries in the field. With nearly 800,000 visits to the Guidelines Web site in 2002, it continues to be a widely used resource.

"As our knowledge and experience with antiretroviral therapies accumulates," says Dr. Bartlett, "it becomes increasingly clear that treatment regimens should be individualized, taking into consideration both the potency of the prescribed regimen and patient-specific factors."

Factors to consider when constructing an individualized antiretroviral regimen listed in the new Guidelines includeThe updated Guidelines include a new table that lists the advantages and disadvantages of individual components of antiretroviral therapy to aid clinicians in the selection of a treatment regimen. Another new table lists regimens or components that the Panel believes should not be used. Sections discussing the following special considerations in initiation of therapy have also been added to the Guidelines:The Panel notes that, with more and more patients being treated with antiretroviral therapy for longer periods of time, the incidence of drug resistance continues to increase.

"We have more clinical trial experience and better strategies for managing so-called 'treatment failure' since the last update of the Guidelines," says Mark Dybul, M.D., NIAID assistant director for medical affairs and executive secretary of the Panel. "Notably, we have gained more experience in using drug-resistance testing to guide the selection of a new treatment regimen once a patient has failed an initial regimen."

The updated Guidelines reflect this new knowledge and experience in a revised section and table on the use of drug-resistance testing in clinical practice. A revised section on the "Management of the Treatment-Experienced Patient" includes new tables that"It is important to remember that the Guidelines is a living document that represents our best assessment of available evidence at this time," says Dr. Fauci. "With time and additional experience, we hope to provide still better guidance for clinicians and patients with regard to treating HIV/AIDS in the future."

The updated Guidelines are available at in two formats, a typeset version (PDF) and a Web version (HTML). Single copies can be ordered by calling 1-800-HIV-0440 (1-800-448-0440) (international callers may call 1-301-519-0459), or by sending an e-mail request to
NIAID is a component of the National Institutes of Health (NIH), which is an agency of the Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, illness from potential agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.

Press releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at

NIH/National Institute of Allergy and Infectious Diseases

Related Adolescents Articles from Brightsurf:

Differences in well-being amongst Somali, Latino and Hmong adolescents
U of M School of Nursing researchers found that acculturation was positively associated with substance use and negatively with academic achievement in adolescence.

Nicotine vapour more rewarding for adolescents than adults
University of Guelph researchers are the first to discover that adolescents react differently to e-cigarette vapour than adults.

Interest in quitting vaping among adolescents
Adolescents using electronic cigarettes were asked if they had seriously thought about or tried to quit vaping.

New guidelines for children and adolescents with T2D
A team of paediatric specialists, including an expert from the University of Adelaide, has produced new guidelines regarding assessment and management of type 2 diabetes (T2D) in Australian and New Zealand children and adolescents.

What influences adolescents to continuously use e-cigarettes?
In a Public Health Nursing study of adolescents who have used e-cigarettes in the past month, certain factors were associated with frequent use.

Fertility preservation use among transgender adolescents
Transgender adolescents often seek hormonal intervention to achieve a body consistent with their gender identity and those interventions affect reproductive function.

Mental health care for adolescents
Researchers examined changes over time in the kinds of mental health problems for which adolescents in the United States received care and where they got that care in this survey study with findings that should be interpreted within the context of several limitations including self-reported information.

Migraine prevention in children and adolescents
Two medicines already used to prevent migraine in adults also showed efficacy in adolescents with migraine.

Smoking cessation treatment targets adolescents
The primary focus of smoking cessation research has been adults in the past, but a new study in JAMA Pediatrics zeroed in on adolescents.

Patterns of substance use and co-use by adolescents
Using in-depth interviews with adolescents (16-19 years of age) who used alcohol and marijuana, this study examines the role that social and physical contexts play in adolescent decision-making about simultaneous use of alcohol and marijuana.

Read More: Adolescents News and Adolescents Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to