GeSIDA/National AIDS Plan: Consensus document on antiretroviral therapy in adults infected by the human immunodeficiency virus (Updated January 2014).
Enferm Infecc Microbiol Clin. 2014 Aug-Sep;32(7):446.e1-42.
Article in Spanish
Panel de expertos de GeSIDA; Plan Nacional sobre el Sida.
This consensus document is an update of combined antiretroviral therapy (cART) guidelines for HIV-1 infected adult patients.
To formulate these recommendations a panel composed of members of the Grupo de Estudio de Sida and the Plan Nacional sobre el Sida reviewed the efficacy and safety advances in clinical trials, cohort and pharmacokinetic studies published in medical journals (PubMed and Embase) or presented in medical scientific meetings. Recommendations strength and the evidence in which they are supported are based on modified criteria of the Infectious Diseases Society of America.
In this update, antiretroviral therapy (ART) is recommended for all patients infected by type 1 human immunodeficiency virus (HIV-1). The strength and grade of the recommendation varies with the clinical circumstances: CDC stage B or C disease (A-I), asymptomatic patients (depending on the CD4+ T-lymphocyte count: <350cells/μL, A-I; 350-500 cells/μL, A-II, and >500 cells/μL, B-III), comorbid conditions (HIV nephropathy, chronic hepatitis caused by HBV or HCV, age >55years, high cardiovascular risk, neurocognitive disorders, and cancer, A-II), and prevention of transmission of HIV (mother-to-child or heterosexual, A-I; men who have sex with men, A-III). The objective of ART is to achieve an undetectable plasma viral load. Initial ART should always comprise a combination of 3 drugs, including 2 nucleoside reverse transcriptase inhibitors and a third drug from a different family (non-nucleoside reverse transcriptase inhibitor, protease inhibitor, or integrase inhibitor). Some of the possible initial regimens have been considered alternatives. This update presents the causes and criteria for switching ART in patients with undetectable plasma viral load and in cases of virological failure where rescue ART should comprise 2 or 3 drugs that are fully active against the virus. An update is also provided for the specific criteria for ART in special situations (acute infection, HIV-2 infection, and pregnancy) and with comorbid conditions (tuberculosis or other opportunistic infections, kidney disease, liver disease, and cancer).
These new guidelines updates previous recommendations related to cART (when to begin and what drugs should be used), how to monitor and what to do in case of viral failure or drug adverse reactions. cART specific criteria in comorbid patients and special situations are equally updated.
Entry filed under: Antirretrovirales, Biología Molecular, CONSENSOS, Epidemiología, GUIDELINES, HIV/SDA en Seniles, HIV/SIDA, HIV/SIDA Co-infeccion HBV, HIV/SIDA Co-infeccion HCV, HIV/SIDA Co-Infeccion HEV, HIV/SIDA Complicaciones, HIV/SIDA Controladores de elite, HIV/SIDA HAART, HIV/SIDA HSH, HIV/SIDA Infeccion Aguda / Reciente, HIV/SIDA Infecciones Oportunistas, HIV/SIDA Laboratorio, HIV/SIDA Lipodistrofia, HIV/SIDA Mujeres, HIV/SIDA Prevencion, HIV/SIDA Trastornos Cardíacos, HIV/SIDA Trastornos GI, HIV/SIDA Trastornos Hemato-Oncológicos, HIV/SIDA Trastornos hepaticos, HIV/SIDA Trastornos Neurológicos, HIV/SIDA Trastornos Oculares, HIV/SIDA Trastornos Oseos, HIV/SIDA Trastornos Piel y Tej Blandos, HIV/SIDA Trastornos renales, HIV/SIDA Trastornos respiratorias, Infecciones de transmision sexual, Infecciones en embarzadas, Infecciones en seniles, Infecciones virales, Metodos diagnosticos, Profilaxis Post-Exposición, Profilaxis Pre-Exposición, Update.