{"id":2979,"date":"2012-07-23T06:50:20","date_gmt":"2012-07-23T10:50:20","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=2979"},"modified":"2012-07-23T06:50:20","modified_gmt":"2012-07-23T10:50:20","slug":"ias-usa-hiv-guidelines-updated","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/ias-usa-hiv-guidelines-updated\/2012\/07\/23\/","title":{"rendered":"IAS-USA HIV Guidelines Updated"},"content":{"rendered":"<p>With the International AIDS Conference in Washington just starting, the International Antiviral <a href=\"http:\/\/blogs.nejm.org\/index.php\/hcv-and-the-retooling-of-hivid-specialists\/2012\/02\/23\/\" target=\"_blank\">(ahem)<\/a> Society-USA has revised its HIV treatment guidelines, updating the 2010 version.<\/p>\n<p>As has been the case for several years now, it&#8217;s published in <em><a href=\"http:\/\/jama.jamanetwork.com\/issue.aspx\" target=\"_blank\">JAMA<\/a><\/em> and also available on the <a href=\"http:\/\/iasusa.org\" target=\"_blank\">IAS-USA<\/a> web site. It&#8217;s a well written, evidence-driven summary of the current state of HIV treatment, with a highly respected authorship group, headed again this time by Melanie Thompson.<\/p>\n<p>It is more fully covered by Abbie Zuger on <em><a href=\"http:\/\/aids-clinical-care.jwatch.org\/cgi\/content\/full\/2012\/723\/1\">Journal Watch: AIDS Clinical Care<\/a><\/em>, but some medical highlights:<\/p>\n<ul>\n<li>HIV treatment recommended for all, with the possible exception of HIV controllers and long-term nonprogressors.<\/li>\n<li>They have shifted towards listing full regimens rather than &#8220;NRTI pair + key third drug&#8221;.<\/li>\n<li>Some abacavir\/3TC-based regimens have moved into the &#8220;Recommended&#8221; category, provided the HLA-B*5701 is negative and the HIV RNA is &lt; 100,000 cop\/mL.<\/li>\n<li>Tenofovir\/FTC\/elvitegravir\/cobicistat (&#8220;Quad&#8221;) is listed as an alternative treatment, with an acknowledgment that this treatment is not yet approved.<\/li>\n<li>There&#8217;s a section on PrEP with tenofovir\/FTC.<\/li>\n<li>Viral load and CD4 monitoring can be reduced to twice-yearly in clinically stable patients. (Of course you don&#8217;t need to measure CD4 <em>at all<\/em> once someone is stable on treatment &#8212; see <a href=\"http:\/\/www.medscape.com\/viewarticle\/738175\" target=\"_blank\">here<\/a> for an explanation.)<\/li>\n<li>There&#8217;s a box nicely summarizing all the changes since the 2010 version.<\/li>\n<\/ul>\n<div>Now for the non-medical summary:<\/div>\n<div>\n<ul>\n<li>The &#8220;USA&#8221; part of IAS-USA is to distinguish this from the <a href=\"http:\/\/www.ias2013.org\/\" target=\"_blank\"><em>other<\/em> IAS<\/a>, which is still called the International AIDS Society.<\/li>\n<li><a href=\"http:\/\/blogs.nejm.org\/index.php\/integrase-inhibitors-in-search-of-an-abbreviation\/2009\/09\/18\/\" target=\"_blank\">Abbreviation<\/a> for &#8220;integrase inhibitors&#8221;? \u00a0InSTIs, which is hard to type, but not nearly as hard as iPrEx.<\/li>\n<li>If you want to target the areas of controversy in the field that nonetheless deserve some sort of comment &#8212; timing of HIV therapy with HCV, abacavir and CVD, use of therapeutic drug monitoring, etc &#8212; simply do a search on the word &#8220;might.&#8221; Guidelines writers love that word when the data are inconclusive.<\/li>\n<\/ul>\n<div>Finally, lots of the the IAS-USA content is similar to what&#8217;s in the <a href=\"http:\/\/www.aidsinfo.nih.gov\/guidelines\/html\/1\/adult-and-adolescent-treatment-guidelines\/0\/\" target=\"_blank\">DHHS Guidelines<\/a> &#8212; I&#8217;m a panel member on that one, and some people have been\/are a panel member on both.\u00a0One might (there it is again) wonder why two such entities are necessary, but I for one value the slightly different perspectives.<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>With the International AIDS Conference in Washington just starting, the International Antiviral (ahem) Society-USA has revised its HIV treatment guidelines, updating the 2010 version. As has been the case for several years now, it&#8217;s published in JAMA and also available on the IAS-USA web site. It&#8217;s a well written, evidence-driven summary of the current state [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5],"tags":[272,423,477,945],"class_list":["post-2979","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","tag-dhhs","tag-hiv","tag-ias-usa","tag-treatment-guidelines"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/2979","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=2979"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/2979\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=2979"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=2979"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=2979"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}