AIDS Treatment Guidelines Revised For Asymptomatic Patients

WESTPORT, CT (Reuters Health) Feb 01 - A revision of current AIDS treatment guidelines calls for delaying antiretroviral therapy in asymptomatic patients until a more advanced disease stage is reached.

"The philosophy of the original guidelines was to hit hard and hit early," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Reuters Health Thursday. "That philosophy was reasonable if you assumed that antiretroviral therapy could eradicate the virus and ultimately get people off therapy."

However, Dr. Fauci explained that since viral eradication is not currently possible, people will likely require therapy indefinitely. "This shifts the risk-benefit ratio to looking at the long-term toxicities of treatment." "If you look at people who have been treated for many years, there is an increasing incidence of toxicities ranging from metabolic abnormalities, lipodystrophy, organ-specific toxicities, and emergence of resistant organisms," he stated.

Previously, antiretroviral therapy was recommended for asymptomatic patients with CD4+ cell counts of less than 500 cells/microliter, viral loads of at least 10,000 viral copies/mL of plasma on branched-DNA testing, or 20,000 viral copies based on PCR testing. The current revision calls for delaying treatment until the CD4+ cell count is less than 350 cells/microliter, or the viral load is greater than 30,000 viral copies by branched-DNA testing or 55,000 viral copies by PCR testing. In essence, "we are setting the bar at a more advanced stage of disease,"; Dr. Fauci noted.

From previous studies it does not appear that delaying treatment in this way will impact survival or time to development of an AIDS-defining illness, Dr. Fauci pointed out. However, this delay may help reduce the incidence of the toxic cumulative side effects. Dr. Fauci emphasized that the treatment revisions were for asymptomatic patients only. "Guidelines for patients with symptomatic disease, acute retroviral syndrome, or CD4+ cell counts less than 200 cells/microliter have not changed."

The revised guidelines, a joint effort of the Department of Health and Human Services and the Henry J. Kaiser Family Foundation, will be released on February 5.